New doc, new insurance, supplies mess up

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susan f
Posts: 1163
Joined: 2005-10-01 21:26:14

New doc, new insurance, supplies mess up

Post by susan f »

I'm venting here. I retired in 2018 and started using new insurance in 2019. The new insurance covers my ostomy supplies without a problem. But the GP I had been seeing for 20+ years was not in their network. So I had to switch doctors.

The new doctor is ok. But I'm pretty sure I am her only ostomy patient and while my old GP had no problem doing the authorization for the supplies I needed, the new one is without a clue.

I went in with a list of supplies, including quantities I use, item numbers, the Edgepark account, phone number, the whole thing. Well, she wrote a prescription for not the right amount of stuff. It has been manageable, I just have to do more frequent ordering, but I can get what I need, its just not convenient.

I tried to get her to correct the quantities, and someone in her office apparently faxed in an order to Edgepark of one box of five New Image wafers for 1-3/4 stoma (my stoma is 1-3/8 and I use Coloplast), one box of 20 Coloplast Brava Barrier strips, and a package 20 of Entrust Ostomy Pouch Disposable Bag, 8" x 8". Not only that, but they made it a continuing monthly order.

If I wasn't so pissed off, it would be hilarious how wrong this is. This is a totally useless order for me, and it doesn't even make sense. 5 wafers, no pouches...

Does everyone else get their WOCN to do the authorization for their supplies? Have I just been spoiled by a GP who got it?
UC Diagnosis 1981
J-Pouch 1988-2002
Permanent ileostomy 2002-now
Crohn's Disease Diagnosis - 2015
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Mara
Posts: 1336
Joined: 2005-09-30 22:13:16

Re: New doc, new insurance, supplies mess up

Post by Mara »

I use Sterling/McKesson - they fax my order to the doctor and he signs it and faxes it back....case closed....My doc doesn't have to write anything - he's my internist - doesn't know anything about ostomy appliances...lol....and doesn't like excessive paperwork which I know from other issues. I don't have a WOCN...

Do you have to use Edgepark? Can they not send a fax with your order - seems a lot easier for everyone....
Ileostomy due to UC - 50 odd years
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To Dream a Dream
Posts: 1414
Joined: 2010-08-10 18:35:53

Re: New doc, new insurance, supplies mess up

Post by To Dream a Dream »

Hi Susan. Great to hear from you. I remember you as one of the very first members to answer my posts back in 2010 when I first joined the board. After years with Edgepark, I had to find other suppliers due to a similar experience. If that is not an option, you might try contacting Coloplast & see if they have a patient liaison or advocate who is familiar with insurance matters. It seems they should, considering you are but one of their own valued consumers. By all means bring it to the attention of your WOCN & PCP. Keeping our medical support teams up to date on the problems we face in keeping our stoma, skin, etc. healthy with adequate supplies is a key to ostomy advocacy.
And you might consider calling Parthenon out in Utah. They have been around a long time thru many changes & are a helpful wonderful family. Good luck & keep in touch.
Crohn's Dx '66 (perforated ileum)
Multiple Bowel Resections
Ileo '77 Revision '85
Celiac Dx
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Snowgoose
Posts: 265
Joined: 2012-03-27 12:25:36

Re: New doc, new insurance, supplies mess up

Post by Snowgoose »

I use Byram and place orders for what I need. If the prescription has timed out or I order something that is not yet approved by my doctor, Byram contacts my doctor for approval (a prescription). It was the same way when I was using Sterling/McKesson. I've never had a WOCN, have always done my own ordering.

I originally used Edgepark. They had the best web site for ordering. They were great until there was a problem, and there were several Edgepark screwups, then the fun begins. Also they charge you up front, sometimes in error. The other mentioned suppliers do not charge you until after you insurance has paid them, thus your balance owed is always correct.

Good luck! Do your own ordering.
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susan f
Posts: 1163
Joined: 2005-10-01 21:26:14

Re: New doc, new insurance, supplies mess up

Post by susan f »

Thanks for the replies!

I have an appointment today with my WOCN, so it will get sorted.

My old GP made everything so easy, I never had to think about it. I've been using Edgepark for years and haven't had any problems until I switched GPs. I proactively told the new GP that she needed to send a prescription to them - that's the one that was mostly right, but not quite.

I can see how it would be better to have placed an order and let them get authorization from her. But she doesn't always seem to get the fax (this holds true with my prescriptions as well, so I suspect the problem is her office). I don't really want to switch doctors again, what a hassle! I think she will be fine in time, and especially in the middle of a pandemic I don't want to have to establish with someone else.

Between her not knowing how it worked, and me not knowing that it would be better to do the order and then let them contact her.... this is partly my mess.

I have seen changes with Edgepark over the years, and not necessarily good ones. But they are taking this order back, and their customer service has tried hard to help me. I really like just ordering my supplies online.
UC Diagnosis 1981
J-Pouch 1988-2002
Permanent ileostomy 2002-now
Crohn's Disease Diagnosis - 2015
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susan f
Posts: 1163
Joined: 2005-10-01 21:26:14

Re: New doc, new insurance, supplies mess up

Post by susan f »

Yeah, so this *really* wasn't an Edgepark problem.

I sent a note through my doctor's office portal that I had gotten this messed up order. The reply I got was:

"I apologize I sent over exactly what you requested."

I requested:
30 Bags
30 Wafers
30 barrier rings
etc, etc ...

I got:
60 garbage bags
5 Wafers
20 Barrier strips

CLEARLY I did not send enough information - I thought they would look at the detailed list (including item numbers) I had in my file. I am restraining myself from replying, because I do believe they thought they knew what they were doing. And it does me no good to piss off the office staff, I will need them again someday. I have an urge to educate them, but I have to believe I am their only ostomy patient, so what is the point? Lesson learned...
UC Diagnosis 1981
J-Pouch 1988-2002
Permanent ileostomy 2002-now
Crohn's Disease Diagnosis - 2015
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Mara
Posts: 1336
Joined: 2005-09-30 22:13:16

Re: New doc, new insurance, supplies mess up

Post by Mara »

To me, ostomy appliances and meds are two things with which I don't want to have any trouble. A couple of years ago for some reason the wafer I use was out of stock in the usual distributors - I even called Convatec. So I ended up finding a supply house online and got my order very quickly - of course I had to pay out of pocket and I never got around to sending it to Medicare - don't even know if they would reimburse. My point being you don't need any aggro - neither is it your job to educate office staff - so you just should do what's best and less stressful for you - can your WOCN help? Can they get the Rx processed??
Good luck!!
Ileostomy due to UC - 50 odd years
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susan f
Posts: 1163
Joined: 2005-10-01 21:26:14

Re: New doc, new insurance, supplies mess up

Post by susan f »

Good news! My new WOCN is a treasure (my previous one finally retired... well deserved!).

She is taking care of things for me, and will include me on the emails to her contact at Edgepark so I am in the loop. We had a lovely lovely talk and I feel so much better!

Bonus for me, she does an ostomy support group and she invited me to their meeting tonight on Zoom. This is something I really enjoy, so I am happy to have the opportunity to support others.
UC Diagnosis 1981
J-Pouch 1988-2002
Permanent ileostomy 2002-now
Crohn's Disease Diagnosis - 2015
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Snowgoose
Posts: 265
Joined: 2012-03-27 12:25:36

Re: New doc, new insurance, supplies mess up

Post by Snowgoose »

So glad it is working out for you. Sounds like you found a good WOCN, that's wonderful.
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To Dream a Dream
Posts: 1414
Joined: 2010-08-10 18:35:53

Re: New doc, new insurance, supplies mess up

Post by To Dream a Dream »

Right on, Susan! God bless your new WOCN!
Crohn's Dx '66 (perforated ileum)
Multiple Bowel Resections
Ileo '77 Revision '85
Celiac Dx
BillGK
Posts: 362
Joined: 2012-09-05 17:47:30

Re: New doc, new insurance, supplies mess up

Post by BillGK »

Susan, if you are still in Arizona then you might consider Desert Suppliers in Coolidge. They are very small, and boy are they wonderful. I used to get my supplies from the Mayo Clinic store, and they were good, but Desert Suppliers is a world apart in service. I am on Medicare, and they actually accept Assignment! A rarity. They seem to have three employees - Patti the owner, Michele, Latisha. Great folks!

I can’t quite figure out your problem, and I don’t think it is the supplier, per se, right? More of a problem with your old doc not being in the new insurance network? In any event, if you ever get your fill of the national suppliers keep Desert Suppliers in mind. They are aces.
BillGK
Posts: 362
Joined: 2012-09-05 17:47:30

Re: New doc, new insurance, supplies mess up

Post by BillGK »

Oops, that's Desert Providers. Not Suppliers.
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ron in mich.
Posts: 1520
Joined: 2005-10-18 11:56:17

Re: New doc, new insurance, supplies mess up

Post by ron in mich. »

Hi Susan my wife recently retired as a state employee and i was on her ins. we were switched to retired emp. ins. and a diff. rx provider and me haveing medicare part A the new provider said i had to have part B also and prove to them i had ins. coverage previously so due to covid no one was in their office so it was a lot of phone tag and faxing so we got it straightened out but then they came back and said my ostomy supplier was out of network. i hate ins co.
MaryPat59
Posts: 2
Joined: 2020-09-22 16:03:30

Re: New doc, new insurance, supplies mess up

Post by MaryPat59 »

Does anyone know where I can donate Hollister ostomy supplies? I have barrier rings, flanges and pouches that I don't want to just throw away.

Help me Help someone else.

MaryPat59
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To Dream a Dream
Posts: 1414
Joined: 2010-08-10 18:35:53

Re: New doc, new insurance, supplies mess up

Post by To Dream a Dream »

https://www.fowusa.org/
A great group of people!
Crohn's Dx '66 (perforated ileum)
Multiple Bowel Resections
Ileo '77 Revision '85
Celiac Dx
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