Diapers through Insurance

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Slomo

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I've been trying to get my diapers covered through my Tricare Prime insurance for three months. I first told my military hospital doctor, then had to explain everything to their case manager. A month later I had to talk to my insurance rep, insurance manager, and appeals rep. Another month and I was telling an appeals manager, 2nd level appeals rep, and finally 2nd level appeals manager. The last few were because my disposable diapers were submitted under the code used for disposable underpads. They are not the same thing, stop calling diapers pads people!

Anyways, we got that straightened out, and I had to start it over again back at my doctors office this morning. I then went right to the case manager and re-explained it all to her, and what and how it all needed to submitted in the right detail. She then also got their distributor involved so we can make sure I'll be able to get them faster. Of course this meant I also spent time talking to the distributor about it all, which included why I'm incontinent, and exactly what kind of diapers I need. (Confidry or Northshore).

It's looking like I'll be able to get them this time too. Though I still have to go through the waiting game again. Whew though! I've spent the last three months telling more people I need diapers than I have my whole life (internet excluded)!!!
 

BabyDenise

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Glad to hear it is moving forward - if a bit slow.

Sometimes I wonder if they spend more money trying to deny the claim and then work through the appeals than they would have spent by just giving the person what they need. :)
 

Spaz

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Arrrghhh. I hate insurance companies. My doctor said she would write a script for diapers 5 months ago and I put it on hold partly because what you are going through and partly because for years I've paid for premium diapers through my flexible spending account and so I already have a ton of diapers at home. I may end up going this route in the future, but I'm not looking forward to it.
 

mikejames

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I've never tried. I just assume pay for them because from what I've seen online, insurance will only pay for certain brands, generally crappy ones. While I hate the expense of my incontinence, I do have a health savings account that helps a bit, at least making them tax free. I'm used to managing my problem with good products like Abena level 4, Dry 24/7, Northshore,and Seni Quatro and I'd not be ok with dropping down to cheapo diapers just because insurance paid for them. Even relying on high end diapers, it took a lot to get me the confidence to feel like I could be out and about with this condition. I've tried a few cheaper brands and none of them gave me that requisite level of confidence.
 

MetalMann

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Yeah, if you're not using FSA or HSA, you're generally going to get what insurance sends you. You don't really have much of a choice.
 

Tetra

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The very best in diapers insurance generally will pay for are ATNS and depending on your level of need will limit your options further as to what is covered and what quantity is available to you. What you get can also be derirmend by what is available ,most HME'S make exclusive "deals" with two manufacturers and you have to shop around to find the most acceptable of the low quality low cost protection , basicly the cheaper the diaper they bill your insurance for the more money that stays in there pocket, I do business with one local HME, serious business my wheelchair alone costs $30,000 but there diaper selection stinks , to even find a place that will attempt to bill for ATNS, I get my diapers shipped from another state via UPS, and it took a rep from PBE and myself making calls two weeks to find this dealer . If cloth is a desired option since you are covered by the VA look to Angelfluff as a supplier , everything they sell execpt some of the babyish stuff is covered by the VA be it diapers , pants ,or onesie. Good luck in finding the "best" of your limited options, my advice is make peace with the cheap ones as a daily "driver" but be prepared to pay out of pocket for something decent to wear away from home, that's the route many of us take to getting a decent level of protection. If I can help in anyway just post or PM me .

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BabelBilly

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It's fun isn't it? I get diapers from my insurance, but they only supply Prevail brand so I use them as a diaper doubler for M-4's or ABU diapers!


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Tetra

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It's fun isn't it? I get diapers from my insurance, but they only supply Prevail brand so I use them as a diaper doubler for M-4's or ABU diapers!


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Didn't the M4 go Cloth? Or something with them changed, brain fart, because I bought a case right before something changed , been sitting on them they use to be my travel diaper until I found for my specific need the Northshore worked better, have a better "front end" in my opinion. When traveling to out of town doctors I have to wear the same one boosted for like 16 hours because there is nowhere to change. Yeah insurance bean counters have not figured out that better diapers equal less changes which means less expense, and in my situation would translate to whole lot less hassle and wear and tear on the muscles.

I suppose prevail is better than nothing , but God I hate those things when I tried them I could still walk and almost guaranteed I would need to change my socks because they leaked.
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BabelBilly

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I have officially revealed to my Mom my 25/7 thing!!! Today!
This is an extremely scary day-i thank God that she lives on the other side of the country!
Here's the deal: she is my medical power of attorney, payee(i'm disabled mentally due to, in my humble opinion & months and actually years of researching what i consider a "disorder") so i felt it was time to finally time to spill the beans and reveal to her that i've been wearing 24/7 since my Mom IS my medical power of attorney, i BETTER tell before she finds out on her own!
Hey everyone; this is really happening in real time! I'm 49 in a couple weeks so i feel that i'm finally old enough to actually NEED diapers- in which is the God's honest truth. Yes, i also have in the past needed them: since the first time i wet the bed at age 4 which is so crystal clear in my head that it actually FEELS like yesterday, and now
currently NEED not want any more...diapers!
Stay tuned!

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Slomo

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So back on topic.

I just found out my insurance denied my diapers, citing I can get them through the VA instead. Talk about total bs which fully goes against their own bylaws. Of course I will be going through their appeals process once again. Uuugh.

In the mean time, I guess I should set up an appointment to get re-established with the va. I hear their wait time is finally down to less than a full year too.
 

Tetra

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I got there on the 7th but have needed diapers due to medical problems since I was in my 20's, it got exponentially worse when i landed in a Power wheelchair, kind of an enduring symbol that I am a broken toy , age has little to nothing to do with IC, if coming out to your Mom only happened now what on earth have you been doing in the meantime .I have two close friends acting as my medical proxy ,one is a Psychologist the other a Physician and they need each other to make decisions , although each is very capable I have a bad habit of rising from the ashes, when doctors have counted me down and out I recover and get back to living my own life .So what is the disorder at the heart of it, that you could not tell your mother about being a DL before now ?

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Tetra

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Ah Slomo your getting the run around, yes the VA will cover them as long as it's service related, otherwise it's the damn insurance trying to penny pinch at your expense, I really think there should be a law that if insurance denies your claim and are proven wrong they should have to pay a $5,000 fine to the claimant , that's a no brainer and would give them incentive to not give people the run around on claims.

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ST50

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Here in the UK if you are diagnosed as incontinent you can get your Doctor or one of the nurses at your local surgery to refer you to the continence service and then the asses your need for pads or slips (nappies) Then if they feel your incontinence is bad enough the continence nurse will arrange for a supply of pads or slips to be delivered to your house on a regular basis.
 

Chinababy888

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I tried that once already in 2010, but with no success and I got the diapers are for babies lecture which really made me embarrassed to be there they just put me on meds that didn't work and I stopped taking them because they were bad for me in terms of allergic reactions.

Next year I am moving into care because of my disabilities and I will be fully re-assesed for that bouth physically and mentally I am hoping that the second time around that I might get a better team of doctors who know what there doing and not the dumb amitires I got the first time around, no offence its just I am still angry over my treatment even after 6 years as I didn't even get the chance to explain that my problems might be related to my past epilepsy which thankfully I don't suffer from anymore and that it might be neurological damage not mental ones as they suggested as that was a completely unsimpatic and insulting thing to say to a 30 year old who went there because of real not imaginary problems.

Anyway usually my treatment at the NHS is a good experience but this one incident I can never forgive them for but aside from that I have a lot of profound respect for anyone in the health care profession in the UK or abroad and I can speak from better experiences as well as the odd bad one so I am 99.9% happy with the NHS in England but I don't think I will ever get over the fact I was passed off as being mental or liying about my problems when I have little to no control over my bladder.

Yours sincerely
Chinababy888.
 

ST50

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I tried that once already in 2010, but with no success and I got the diapers are for babies lecture which really made me embarrassed to be there they just put me on meds that didn't work and I stopped taking them because they were bad for me in terms of allergic reactions.

Next year I am moving into care because of my disabilities and I will be fully re-assesed for that bouth physically and mentally I am hoping that the second time around that I might get a better team of doctors who know what there doing and not the dumb amitires I got the first time around, no offence its just I am still angry over my treatment even after 6 years as I didn't even get the chance to explain that my problems might be related to my past epilepsy which thankfully I don't suffer from anymore and that it might be neurological damage not mental ones as they suggested as that was a completely unsimpatic and insulting thing to say to a 30 year old who went there because of real not imaginary problems.

Anyway usually my treatment at the NHS is a good experience but this one incident I can never forgive them for but aside from that I have a lot of profound respect for anyone in the health care profession in the UK or abroad and I can speak from better experiences as well as the odd bad one so I am 99.9% happy with the NHS in England but I don't think I will ever get over the fact I was passed off as being mental or liying about my problems when I have little to no control over my bladder.

Yours sincerely
Chinababy888.

So sorry to hear of your bad experience with the NHS. I was refered to the continence service after the urology clinic had done all their tests and I had seen the urologist. My diagnosis was incontinence due to Diabetic Neuropathology. In other words nerve damage. This has been caused by me having undiagnosed diabetes for so long. They did give me Vesicare and then another similar drug which had very little or no effect other than making my sight blurred. The Continence nurse knows I don't take it any more but always says I should really.
 

Slomo

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I should also mention that while I am incontinent from injuries sustained while in the military, I effectively hid it as at the time I didn't want it in my records. I can not get diapers through the VA unless I go through re-evaluation (which was such a pain before I do not wish to go through it again. While I am over that initial embarrassment, I still cannot go that route. Looks like I have more fighting with my insurance then.
 

lilbing

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I found out rather quickly that it is a pain in the butt to get insurance to cover diapers. I have both medicare and medicaid and recently found out that medicare doesn't pay for diapers. Seriously? Medicare will pay a huge amount for one of my meds but refuses to pick up the tab for diapers. Anyways my medicaid only covers what medicare doesn't. So I will be looking into that. I would be happy with tranquility ATN's or even slimlines. But I have read on this thread that you need the utmost best insurance for those. I can't stand breathable diapers and I am sure that is what they will send if I can ever get approved. I currently pay out of pocket for premium diapers and that probably won't change. I'm also on disability for psych, you would think that being on SSD would help, but nope. I have 3 doctors, 1 PCP and 2 urologists writing RX's for diapers, but yet I can't get them filled.
 
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