Insurance Coverage for Koch Pouch Supplies

[daisymay5]

Hello, I have had my Koch pouch since 1982 and use non sterile gauze pads and surgical tape. Up until late last year, my insurance company has denied what partial coverage they had provided for me the past 6 years since I had been with them. I had noticed my coverage had decreased quite a bit since early last year and when I questioned it, the insurance company said I shouldn't have had coverage all along as they consider these over the counter and that I could have to pay it back upon further review, despite having all the doctor's note of medical necessity, prescription, etc. in place for the past 6 years. I had switched plans this year and the new insurance company is also denying these items, so I am wondering if this is common practice now for these type of supplies for Koch pouches? Despite having different types (HMO, fee for service) of medical plans since 1982, I have always had some type of coverage for these. Thank you for your feedback.

[smoki]

Hi daisymay, I am new this whole thing but I found out today that my insurance has a different deductable for supplies and I need to pay 80% of the cost! That should run me $85 to $100 a month! That is a disgrace after what I pay for health care insurance. The only good part is, I am due for a reversal in June. The bottom line is, it looks like I work to pay health insurance and now I pay 80% for materials.
Sorry about your insurance too.

[squid56]

Sounds about right. I had insurance that used to cover gauze and tape but no longer. For the past 3 years they have also discontinued covering catheters! At least I can claim it on my income tax forms. Judith

[LindaAukett UOAA Advocacy]

That sounds a lot like what United Healthcare used to tell people when they started denying claims for ostomy products about 11 years ago, "Don't complain or we'll go back and ask you to repay what we paid out for you for years."

Please click on the envelope to the right and send me an email with the particulars - where you are, what insurance company, whether your employer self-insures and so on. Maybe I can make some useful suggestions.

Thanks,
Linda

[daisymay5]

Thanks everyone for your feedback. I really had no idea that this is a common practice these days. Since everything is now out of pocket, I started to look for online vendors and got too overwhelmed by all of the choices and who was reputable, etc., and then it dawned on me to go back to my original local ostomy pharmacy that I ordered from way back in 1981 when I first had my surgery when I used the traditional bags, wafers, etc. The only reason I had to stop using them back in the late 1980's was because of insurance purposes. If nothing else, I have come full circle with my supplier. Linda, I have sent you an email as you requested. Thanks again to all!

[DianeLeigh]

I would also like to offer my help. Linda has my contact info, or you can PM me.
It's not uncommon for an insurance company in this day and age to deny for gauze and tape, unfortunatly, but it is a good possibility that they just don't comprehend what you are using it for.

Squid,
I would be interested in finding out info about your issues as well. Catheters are becomming more and more recognizable as necessary even tho they are disposable.

Best of luck -
D