Why will my healthcare provider not cover catheters???

[MarkB701]

I used to have BCBS insurance and they provided 150 catheters per month plus 2 foleys and leg bags.

In January, the company I work for switched to United Healthcare. I still pay the same premium (of $150 per month), but they specifically exclude disposable supplies, including catheters.

Since January I have been re-using catheters. I use about 2 per week (one at home, one at work).

Does this sound right? I work for a big company (Pirelli Tires) have full medical insurance, and get zero help with urological supplies???

Any feedback would be really helpfull


[Ok, I spent 5 mintues trying to figure out which room to post this in. I think CCF has far too many rooms FWIW.]

[quadfather]

They should be covered since pretty much every large insurer follows Medicare funding decisions (which covers cathethers).

Where is Steve Winter?

[SCI-Nurse]

Have you appealed this decision? It is worth a try. It is more likely that that your employer chose a cheap insurance with very limited coverage, and you may be out of luck. Have you talked to anyone in your HR department about this? There is no requirement that any insurer cover any specific type of supplies or equipment, and many sell cheaper insurance to employers by cutting benefits included drastically.

(KLD)

[MarkB701]

Have you appealed this decision? It is worth a try. It is more likely that that your employer chose a cheap insurance with very limited coverage, and you may be out of luck. Have you talked to anyone in your HR department about this? There is no requirement that any insurer cover any specific type of supplies or equipment, and many sell cheaper insurance to employers by cutting benefits included drastically.

(KLD)

Thanks. And yes, I appealed earlier in the year and it was rejected by United.

When I complained further to HR they simply shrugged and said I should have done my homework, realized I was not coverred and put the maximum of $5k into my health savings account.

Personally, I cannot understand the mentality of someone who will save the company a little cash that so fundamentally affects the benefits of just one person. To me it is immoral.

Not sure I have a leg to stand on (so to speak) legally. And I can't exactly take my business elsewhere, this is the one product offered at work.

Any other suggestions???

[wheeliecoach]

I used to have BCBS insurance and they provided 150 catheters per month plus 2 foleys and leg bags.

In January, the company I work for switched to United Healthcare. I still pay the same premium (of $150 per month), but they specifically exclude disposable supplies, including catheters.

Since January I have been re-using catheters. I use about 2 per week (one at home, one at work).

Does this sound right? I work for a big company (Pirelli Tires) have full medical insurance, and get zero help with urological supplies???

Any feedback would be really helpfull


[Ok, I spent 5 mintues trying to figure out which room to post this in. I think CCF has far too many rooms FWIW.]

I have United Healthcare...and both my husband and I are disabled. We have no issues getting the stuff we need. My husband gets enough cath kits to go 5 times a day...and we have not had any issues. I would definitely appeal that decision.

[Faithful1990]

Mark,
We have UHC as well. My son's catheters ARE covered. HOWEVER, every month they decline the item and I have to call them. The code the use declining it on the EOB (Explanation of Benefits) is DME, which we all know catheters are not durable medical equipment. Every month, I receive a different answer as to why they coded it DME, once they stated it was because the vendor sells DME.????? Anyway, after about 30 minutes on the phone, they resubmit the claim and the catheters are paid for. For us, UHC only has one vendor on their list for purchasing catheters, which is Edgepark and they charge much, much more than others. It's very frustrating to make the calls EACH & EVERY month, but it works.

[MarkB701]

I think my company got the cheapo insurance that excludes disposable supplies. They have lumped catheters in to things like bandages, OTC medicines etc.

I have made like 3 boxes last over 10 months. I have had a few UTI's. I'm paid well, but I have so many other expenses, that I don't think I should be spending my hard earned cash just to pee.

My premiums are $305 per month plus whatever Pirelli pays.......

[wheeliecoach]

Mark,
For us, UHC only has one vendor on their list for purchasing catheters, which is Edgepark and they charge much, much more than others. It's very frustrating to make the calls EACH & EVERY month, but it works.

Wow...we have a number of different places to get the caths from...and we are currently using ABC Medical. My husband used to use Edgepark before we were married and he was covered under Cigna...but ABC Medical seems more reponsive and also helps support our basketball team since 5 members of our team go through them.

Sorry about your issues Mark!

[sjean423]

re edgepark, The price listed on the site is not what actually gets charged out to the insurance. I use them b.c my previous insurance insisted on it. I have just stayed with them (easier than switching) even tho my insurance changed, and it seems my co pay is comparable to what it would be with other suppliers.

I don;t get why they post the prices they do, but??

(As they give a discount off that, if stuff isn;t covered ....go figure?)

[SCI-Nurse]

Did you get your doctor to write a lprescription and a letter?

CWO

[MarkB701]

Did you get your doctor to write a lprescription and a letter?

CWO

Yes. Made explanations that I have a neurogenic bladder, that I needed the catheters to live etc. All to no avail.

It's ironic because I spend my life talking up the standard of healthcare here versus the NHS back home in the UK. But at least back home I wouldn't be forced to pay full cost for catheters and have to wash them to the point that I use just 2 per week.

Any further advice is very welcome.

[thehipcrip]

Mark, call United Health Care and request a case manager. They are in house advocates who can do wonders to help you get past denials.