Urinary Incontinence Support Group

I have already noted in many posts that the best way for me to deal with my incontinence is by using adult diapers. I have gone through the meds, self cathing, Foley Catheters, External Catheters, Botox Injections, and I am not a candidate for the InterStem so the only thing left is diapers. Per my urologist his next step would be to remove my bladder and have me wear a Urostomy Bag. At this time, even the urologist isn’t comfortable with doing this because of abnormal problems I have been fighting since 2007. Therefore he has written me a prescription for adult diapers.

When I went to the Home Medical Store and turned in the prescription my insurance denied it. I turned in a written appeal of the denial and they came back and denied it again stating they do not pay for disposable products but I could request a second appeal. Well I did, I wrote another letter of appeal and explained everything even in more details and explained that the diapers is the only treatment that is allowing me to live a productive life. Again I received a denial letter stating the same thing but I could request to be heard in front of a grievance committee if I didn’t agree with the denial. Now writing letters isn’t that hard, but to move forward I would have to sit down in front of strangers and explain why I feel my insurance should cover my adult diapers. So I turned in my written request and was given the opportunity to sit down in a conference room with about 10-12 people there telling them why I have to wear diapers, what all I have gone through, what all the insurance has already paid out and tried to explain to them that other disposable items such as catheters and Urostomy supplies are covered and they are disposable items.

This was one of the most nerve racking meetings I have had to deal with. Out of the people there, only five of them were voting on whether or not this should be covered and then it was going to be turned over to the CEO of the insurance company to decide. Out of those 5 one was a family doctor. The doctor even agreed that diapers are a treatment. In the half hour I was there, I got 15 min to explain and then it was answer and question time. The doctor is the only one that asked questions. After the meeting was over I was escorted out and would not find out what they decided for another two weeks.

Those two weeks have passed and today I received another denial letter. Again they claim they don’t cover disposable items unless provided by skilled nursing. They did say I could send in $25 and request another appeal and they would set this up with an outside company. I am on the fence right now about this final appeal. If I can’t go into it with proof that other insurance companies are covering diapers and or somehow prove to them that this is the only treatment, it will be a waste of time and more money. They have all the money needed to keep fighting this but I don’t, I need my money to buy the diapers.

Has anyone had their insurance company cover diapers or know of any that do? Am I wrong for asking my insurance to help with the cost of diapers? Should I play their game and see about having a skilled nurse somehow bring/deliver diapers?

What really bothers me about all this is that they have and are willing to pay the following:

Botox Injections - $20,000

Foley Catheter and supplies - $300 + per month

Self Catheters $200 + per month

Bladder Removal Surgery and then all the Urostomy Supplies - $$$$$$$$$$$$$$$$$

But I can’t get them to see the saving of covering my adult diapers at $160 or so per month.

Sorry for the long post but I am at a lost and so frustrated right now I really don’t know which way to turn and or keep going. Part of me wants to go ahead and give up. My urologist has already said to me that he is amazed that I haven’t given up and requested disability for all that I have going on. I told him that I don’t want to quit, I want to live a productive life, but now I really don’t know. Insurance companies really don’t care if you live a productive life or not, they just want to follow what they have down on paper.

I wish I knew exactly what to tell you, and I certainly hope that someone has an answer out there for you regarding precedence of covering diapers as medical supplies. However, this has been my experience as the mother of a diabetic child.

When my son was newly dx'ed in 1991, we had some issues over what was covered and what was not for diabetic care. They refused to pay for some items, and my husband (though we were not married at that time) threatened to sue the insurance company for denial of medically necessary goods. Funny, how quickly they folded when an attorney got involved.

Years later, following my first brain surgery that our pathetic insurance company at the time refused to pay for, I found a Christian attorney willing to represent me at minimal cost (friend of a friend). Just the mere threat of a lawsuit cleared up 2 1/2 years of WAITING for insurance pay-offs. Unfortunately, due to the stupid insurance company's lack of attention to these bills, I lost an excellent area neurosurgeon who blacklisted me as a patient as a result of "slow payment".

It is hard for me to appeal and appeal and appeal things because I haven't got the patience or endurance for it, so I pray that you can keep up the fight until you get the answers you need.

~Mary

I am in Australia, and here those of us who are deemed to have 'severe incontinence' as classified by any registered Medical Doctor,or Registered Continence Nurse, can apply for and receive an annual grant towards the cost of continence aids OF OUR CHOOSING. The Doctor or Nurse makes recommendations on the application as to the best type of products in each case, but as patients we still have FREE CHOICE in the actual products we use. It must be said that the grant is not sufficient to cover the whole cost of products, but it cartainly goes a good way towards it one you get 'expert' in choosing.

As I have been harping on about External Male Catheters being a much cheaper option (approximately HALF the cost of diapers) I have been surprised that this topic has had only ONE response.

It just seems cruel to me to put any of us with Medical Issues like this through a legal battle to obtain basic care.

Wishing you blessings in this painful journey

Gordon

I am also fighting at the age of 51 to get dissability as it is getting hard for me to work yes I do work from home but in a call center enviroment high stress oddball hours limited days off and never in a row or on the same days working till 12:00AM when the corp I work for knows what it does to me and the list could go on.

All I can do is pray for you my friend and understand what you are going through please keep us posted on this.

Cyrup22 I am glad that the cath works for you as it does for other men but for me I did not like the hassle as it is both Urinary and Fecal for me so I would still have to wear a diaper anyway good luck with the cathing and please keep us posted on it also.

God Bless All.

Post edited by: diaperman, at: 09/06/2011 12:06 PM