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    Help with purchasing catheters

    I have United Healthcare Virginia insurance that will not pay for catheters (United Healthcare doesn't pay for disposable medical supplies.... strange isn't it?), I'm wondering if anyone was in a similar situation and could tell me what did you do to solve this problem. Also, is there anyone who pays for hydrophilic catheters out of pocket? If so, please give me information where I can buy it for a reasonable price....this is urgent.

    #2
    I've bought my own a few times, to keep a buffer supply. Here's where I've purchased some in the past.

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      #3
      I can still only get medicaid to pay for a single foley catheter monthly even after a kidney abscess. Everything else I get by paying out of pocket at a local surgical supply store

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        #4
        The one time I bought catheters I went with the cheapest ones I could find and ended up buying PVC caths. They are pretty stiff and I ended up bloodying myself with them, so I'd say avoid those even if you find them cheap.

        I use the clear plastic type catheters. They are flexible but not as much as the red rubber ones. The reason I like the clear ones is that you can see the urine in them and spot any cloudiness that might signal an infection early.

        Good luck! Buying catheters out of pocket is a pretty big expense, easily $1500/yr. Many people have luck washing and reusing catheters but in my experience I can't avoid infection that way.

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          #5
          if u need catheters i have a boatload of them due to my huge bladder capacity, etc. anyway let me know and i could ship em to you. i've got unisex bards 14s that are connected to a bag as it's the only thing i've ever used since re-hab days.

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            #6
            kel13, what a generous offer. Infinitely cool of you. Hope they can work out for PKF.

            PKF -- check out this thread by MarkB701, who asked this same question last fall. In the replies are good suggestions for what to do (appeal the decision, monthly if necessary; get a case manager at UHC -- they act as internal advocates for you; if your employer offers another option for insurance, switch).

            There's also a list of users in that thread who have fought UHC and won (you could message them for help on how they did it) and lost (ask them where they buy affordable caths).

            If your insurance still won't cover, look into setting up a Flexible Spending Account for Health Care. A FSA allows you to put up to $5k of pre-tax dollars in a savings account, and then use that money to pay for medical expenses like caths, health insurance premiums, etc. It doesn't change your OOP costs but the money you put into the FSA account isn't counted against your wages for income tax purposes so you could end up paying less fed/state income taxes.

            Best of luck! Hope you get something that works for you right away.
            It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

            ~Julius Caesar

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              #7
              Originally posted by PKS View Post
              I have United Healthcare Virginia insurance that will not pay for catheters (United Healthcare doesn't pay for disposable medical supplies.... strange isn't it?), I'm wondering if anyone was in a similar situation and could tell me what did you do to solve this problem. Also, is there anyone who pays for hydrophilic catheters out of pocket? If so, please give me information where I can buy it for a reasonable price....this is urgent.
              My urologicals supplier, Phil Dye @ UTI Medical, called me this morning about my next order and while I had him on the phone I read him your post. He had an interesting insight as to how you might be able to get your catheters covered through UH, as he's come across your situation before. You can reach him at 877-786-7884.
              stephen@bike-on.com

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                #8
                If you have Medicare as secondary, don't they pay for 200 catheters per month? If you didn't keep Medicare, or were never on it, the point is moot.
                Please donate a dollar a day at http://justadollarplease.org.
                Copy and paste this message to the bottom of your signature.

                Thanks!

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                  #9
                  not how it works in CA rdf.
                  I was on Medi-Cal for 2 yrs then automatically got Medicare as primary, Medi-Cal as secondary.
                  anyway I always got 150caths, had medical documentation for 180 for a while but now that Medicare is primary they REFUSE to Up me to 200 caths/month.
                  I'm not going to fight w/ them as my bladder is huge but I always have UTIs but oh well life is short and I'm not one to deal with insurance headaches!

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                    #10
                    With UHC insurance you may be able to do a carve out policy that will include Catheters or allow disposable equipment. I work for a DME supplier and verify insurance and only run into UHC paying for caths in a blue moon. The Health Savings Account is a good idea if you need to have hydro's.

                    Kel13-- as long as you have the proper paperwork from your dr as to why you need to cath,(not just paralyzed) then medicare will cover. If you have any troubles with it let me know. Our company is trying to get in with Medi-cal but is having issues with them right now. We deal with a lot of medicare pt's. you can check them out on the web. 180medical.com. The founder of the company is a T7 Para and is very understanding. We ship all over the U.S.

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                      #11
                      Everyone- thank you so much for the insightful information. After realizing how bad my insurance is, I've decided the easiest and only way to do this is paying out of pocket because the appeal I've written will probably not help much anyway.
                      thank you all!

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                        #12
                        Thanks for the insight-UHC paid for catheters!!

                        Hello. I have been a long-time lurker on this site. My child requires cathing every 4 hours due to her neurogenic bladder. We have had UHC for years, and for years we have been having to pay put of pocket for her supplies. Related to the advice I read on this site, I decided to make my yearly call to UHC and attempt to see if her catheters would be covered. I actually got a "yes"!! I called 1-80-Medical (877) 688-2729 and spoke with Brett, he knew exactly what codes and how to get UHC to pay for them. We even got the touchless kind. Thought I'd let you know, so if you have given up on your insurance paying for your supplies, it might warrant a call to check, something may have changed, or maybe Bret can help you get codes that they WILL pay for. Thank you again.

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                          #13
                          I am wondering if your catheters are being prescribed and coded correctly. Every health insurance coverage I have had considered intermittent and foley catheters Durable Medical Equipment (DME)-not disposable medical equipment-under this definition:
                          A urinary collection and retention system with or
                          without a tube is a prosthetic device replacing
                          bladder function in case of permanent urinary
                          incontinence. The foley catheter is also considered a
                          prosthetic device when ordered for a patient with
                          permanent urinary incontinence.


                          Lubricants and antiseptic wipes have not been covered because they are classified as disposable items. I always thought it odd that insurance would cover the catheters, but not cover the items to make them easier and safer to use.

                          All the best,
                          GJ
                          Last edited by gjnl; 26 Apr 2012, 7:23 PM.

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                            #14
                            Originally posted by PKS View Post
                            I have United Healthcare Virginia insurance that will not pay for catheters (United Healthcare doesn't pay for disposable medical supplies.... strange isn't it?), I'm wondering if anyone was in a similar situation and could tell me what did you do to solve this problem. Also, is there anyone who pays for hydrophilic catheters out of pocket? If so, please give me information where I can buy it for a reasonable price....this is urgent.

                            When we had United Healthcare they paid for catheters...along with other things. I think you should challenge that...
                            "Unless someone like you cares a whole awful lot nothing's going to get better. It's not." - Dr. Seuss

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