Edgepark Data Breach

[BillGK]

Diane, you say Medicare and Blue Cross. Do you have original Medicare with a Blue Cross supplemental? Or do you have a Medicare Advantage plan that is written by Blue Cross?

Big difference. If Original Medicare the rules for what is covered and how much Medicare will pay and where you can get your supplies may be very different from the rules that come with an Advantage plan. Rules for supplies with original Medicare are fairly uniform. Rules from one Advantage plan to the next can vary, they are plan-specific. Insurance rules for "durable medical equipment", which is how ostomy supplies are classified by Medicare, can get tricky.

Edit:. Oh, and let me add something. We users of ostomy supplies are an exceedingly small percent of the total insured population. Combine this with the fact that ostomy supplies are classified as "Durable Medical Equipment", and most durable medical equipment suppliers are into things like like hospital beds and wheel chairs, and they don't even deal with ostomy supplies. Now you call an insurance company, and you get a telephone agent who has been on the job for three months, and the circus begins. If you have an Advantage plan they will give you the names of DME companies in "their network", and you call the companies, and they don't know an ostomy supply from an osmosis filter because they sell wheelchairs and crutches. And if you are on original Medicare most places that actually do deal in ostomy supplies that have a local presence - like Walgreens and CVS - won't accept Assignment. It is a very frustrating and confusing problem for many ostomates.

[Diane C]

Thanks, BillGK,

Did something change THIS OR LAST YEAR with Medicare? My homework is to read the fat pamphlet I have on Medicare. I turned 65 2 years ago. I've had very good primary insurance through Federal Blue Cross. Now that insurance is secondary. When I signed up for Medicare and Part B (never heard of Medicare Advantage), everything ostomy-supply-wise changed for the worse. Not only am I paying hefty Medicare premiums (but surgery and almost all "standard" medical bills are fully paid; my co-pay for most prescriptions is quite low) but I expected the limits from Medicare. They just seem to be more stringent now? Medicare has no clue if pouches leak or how many one must use in reality. Grrr. I just preferred the system when I used Blue Cross and paid a minimal co-pay.

HOWEVER -- and this is very puzzling and I must call Blue Cross on Monday, Edgepark told me that my Blue Cross deductible was barely paid which does seem correct as my out of pocket costs have been stunningly low since hefty surgery and wound care plus a skilled (?!) nursing care facility, home health care visits, out-of-home PT and more once you deduct my payments to Medicare. My recordkeeping has gone south since my surgery last Nov. That's apparently why I'm paying so much for the ostomy products once Medicare denied some and they went to Blue Cross.

I must also call Convatec re the billing codes -- example -- Stomahesive strips and Ease strips (I really like the latter) are apparently the same so I could only order one box of each which is way too minimal. I've several questions for Convatec. Edgepark also told me that the high output pouches were no longer available. Convatec is coming out with a new catalog soon but the savvy rep I spoke with sure didn't say anything about this. So I wish I'd ordered a 1- or 2-month supply, not 3 and gotten answers first. I have not apparently met my secondary insurance -- Blue Cross -- deductible -- thus the high cost. I feel very irresponsible as I pay my bills on time and should know this but clearly must investigate. I obviously am confused by the current medical system. Go figure -- I used to work at HHS and SSA -- but not in this area. I need a good tutorial -- but first -- must call Blue Cross. Was just too busy yesterday with the doctor appmt and errands.

And need to get this laptop repaired ASAP... so may be offline for a while tho think I can borrow someone's.

T-you! Duh!

Diane C.

[BillGK]

Hey, wonder of wonders. I got a notice saying that my Cymed samples will arrive this week. I ordered them in early June.

I have been trying a number of different supplies, primarily looking for a wafer that I can rotate with the Convatec wafer that I have been using continuously for over 5 years. My skin is perfect - knock on wood - but it would be wise to not keep all my eggs in one basket.

An interesting thing is, I have found a better bag as part of the process. I currently use Coloplast disposable bags with the Convatec wafer (any two products that stick together work for me). I really like the Coloplast Mio drainable bag and am going to start using it. It has a seriously improved filter that actually works, it has an easy to clean tail, and it has a number of other good features.

As to wafers, Convatec has a moldable product that has worked very well, and they tell me that the materials of both the wafer and the tape are different from what I am using. So, it’s a good option. I tried the Coloplast Mio wafer without much luck. Cymed is the other possibility, so long as the Mio bag will stick to it and it doesn’t leak.

We are blessed to live in a time when we have an abundance of ostomy products that work well and provide options.

[KBD]

Sadly, pretty much any site can be hacked. It is the risk of buying/paying for anything online. You can set blocks on your credit so no one can take out new credit lines in your name, and monitor your credit with Credit Karma or some other site. It would be nice if online sites did a better job securing our data, but the risk will always be there.

[Diane C]

Great to hear re the Cymed samples. I had to go ahead and put in an order without Cymed. Ordered Convatec which has been pretty good for me. But definitely want to experiment more now that I have the ileo. I'll contact Cymed again.


Many thanks!

Diane C.