Blue Cross Blue Shield

[IndianaDaisy]

I was invited into the home of a new colostomy patient. His supplier was there helping him get set up with supplies. The supplier told the patient his insurance (Blue cross/Blue Shield) only covers limited Securi-T products. Hollister, Covatec, Coloplast, etc were NOT an option for this patient?

Has anyone else experienced this? Is this a new thing with Blue cross?


...on a side note:
This patient had a short 8 day stay in a rehab center prior to going home. The only ostomy supplies the rehab center had were irrigation bags, so that's what they used and that's what they sent him home with. This poor man was discouraged about having to live with this HUGE (...and it WAS huge) bag that hung down past his knee!! Thankfully, his supplier set him up with the appropriate appliance and he was much happier.

[Mysticobra]

I have bcbs.
I would call a different supplier.
Do you know which one it was?
Jeez. That sounds like just putting more misery on top of someone who gets through this life changing event.
I get convetec through Byram. Have gotten Coloplast also.
Why would he say they don't cover two of the largest companies out there? Weird.

Richard.

[BillGK]

Any single insurance company will normally have different plans, for different situations, with different provisions, in different states. In my state BCBS offers a number of different plans. You have to read the specifics of the individual policy in order to know the answer to these sorts of questions. It isn't necessarily going to work, to try comparing one set of benefits to another, thinking that just because both policies are BCBS the benefits and rules will be the same.

[HollyM]

I have BC/BS and have had no issues ordering any brand that is offered through Edgepark.

[vincefaiola]

Certain dealers make arrangements with manufacturers for certain insurance plans. Call your manufacturers education and support line and they’ll help you find a dealer who takes your insurance.

[MyBernard]

I am wondering if they should just call their insurance company. Sounds like they need some clarity directly from the horse’s mouth. The first company I dealt with was far more interested in pushing the expensive product than what would actually work for me. I have unbelievably amazing insurance and I am sure they looked at me and saw only $ signs. Used the expensive (but miserable) products they sold me until I wised up and called companies for samples.

[vincefaiola]

Trust me- this is the supplier (likely a local dealer) who is looking to use generic products to increase profit margin. All products are covered under the same hcpcs codes depending on type of product. Find a new supplier and the problem will go away

[d1shak]

I have BC/BS and have had no issues ordering any brand that is offered through Edgepark.

Edgepark recently told us that they no longer are in contract with Blue Shield. Has anyone found an ostomy supplier that is in-network with BC/BS?

[agichk]

I have BC/BS and have had no issues ordering any brand that is offered through Edgepark.

Edgepark recently told us that they no longer are in contract with Blue Shield. Has anyone found an ostomy supplier that is in-network with BC/BS?

Edgepark is national supplier for BCBS. I would go to your website, put your zip out 100 miles and see what comes up. I know Byrum is natioanl for them also. Maybe with new year there was a glitch.

I work as case manager when not on medical leave and most of my co workers show that many BCBS members use edgepark.

I am new to ileostomy and called benefits who could not tell me how much of the DME supplies that are listed for Medicare that I could receive per month as would depend on the order.

[NEskier]

I have BS/BC and use Edgepark. No issues. I'd call and ask a bunch of questions.

[downttb+-wh]

I had BCBS and they covered it. I used Hollister.

[Diane C]

Hi all,

Bill answered correctly above. Blue Cross Blue Shield differs according to the actual plan you have and in which state the provider is located. I have Care First Blue Cross offered by the Federal Government (I worked for the Feds and am a retiree -- although I want to start looking for part-time work elsewhere once I feel my health is under control more.) I also now have Medicare which seems to change my status of coverage quite a bit but I'm still trying to figure it out. Medicare puts limits on the amount of supplies one can order. I'm unsure if my Blue Cross policy can override Medicare's allotment after a provider bills Medicare. I need a major tutorial on Medicare and must sit down with the fat pamphlet (book?) that was mailed to me.

Really surprised to hear that the hospital provided an irrigation sleeve and sent a patient home with one. While I do wear my irrigation sleeve often because of much output -- esp if I know I can't empty a pouch for 2+ hours if I'm ushering at the theater or something similar -- a high output pouch SHOULD be sufficient. Most health care facilities I've been to don't even HAVE irrigation sleeves unless teaching a patient how to irrigate. Still doing that with my "new" ileostomy as of November 1 after having had a colostomy since 2002. And yes, still experimenting with different amounts of Immodium. Ought to open up a lab!

Diane C.

[Eugene Treviso]

I have Excellus Blue Cross/ Blue Shield in upstate Western New York and have had no
Issues.