Ordering Ostomy Supplies 101

For products on which assignment was not accepted and/or for customers who were not Medicare beneficiaries, the retail price was determined. Additionally, the shipping and handling policy and related charges were ascertained. Since around two-thirds of people with an ostomy are Medicare beneficiaries, it was important to determine the suppliers' policies with regard to Medicare, but it was impractical to try to obtain information with regard to the hundreds of other private insurances that many of the suppliers accepted.

Medicare customers might prefer to patronage such a 'hometown' dealer if they accept Medicare assignment (see sidebar) or if the customer is willing and able to pay at the time of purchase, file the necessary reimbursement forms and wait to get their check from Medicare (usually just 4-5 weeks). It is increasingly difficult for local suppliers to accept Medicare assignment because of the small difference between wholesale prices and the amount that Medicare is willing to pay. UOAA, and our forerunner UOA, have worked hard to convince Medicare and Congress to keep these payments at a level that makes it possible for local suppliers to keep accepting Medicare assignment.

A subset of the local dealer is the one that specializes in ostomy supplies. This dealer might be someone who has an ostomy (or a family member does) or they are or have been a WOC Nurse or ET. Personal service and problem-solving assistance is a real plus when dealing with this type of supplier. This group faces many of the same problems of other local dealers when it comes to pricing or being able to accept Medicare assignment.

National/mail-order suppliers. Another major category of suppliers is the national/mail-order companies. They stock a large selection of supplies and their prices tend to be on the low side as well. Possible drawbacks are shipping delays/expenses (especially for any returns) and limited or no special orders.

Based on a survey of mail-order suppliers a few years ago, it is my analysis that the mail-order companies use this advantage to do business in one of two ways: they either lower their retail prices as much as possible or they focus their business on accepting Medicare assignment as much as possible. Only a very few find it possible to do both.

All of them have toll-free numbers, give excellent and quick service, offer free shipping on retail purchases above a certain level, and most have staff who are able to give advice regarding management problems. Most also now have their catalogs online and accept orders through their websites. 

Since the explosion of the Internet, we have seen the emergence of some hybrids. They started as a local supplier and have branched out into the mail order end of the business by developing a website with an online catalog and ordering capabilities. Many of these hybrids offer a limited number of product lines and rarely accept Medicare assignment. Some don't even have Medicare supplier numbers, so the customer has to do all the filing of claims in order to be reimbursed.

Which Type is Best?

This is a question that has no single answer. It will always depend on whether it is better for your unique situation. Your mobility, your insurance, your economic situation, your specific supply needs, your preference in making a selection - these will all enter into the decision you make about which supplier to use. There is sufficient variety among the existing suppliers that you ought to be able to find one that will suit YOU better than the others.

How To Find A Supplier

If you or a family member are in need of ostomy supplies, there are several ways to locate them. From ostomy publications to the phone book to your insurance provider, we will cover the main ways to locate an ostomy products supplier.

The introduction of CB, sometimes called Competitive Acquisition, has attracted much publicity. CMS hoped that it would enable it to save money on the medical equipment and supplies provided to Medicare beneficiaries.

You may be able to get names of suppliers from Medicare or from your insurance company. Medicare will give you the names of "participating providers" who have agreed to accept the Medicare payment plus your co-payment for supplies. From research, we know that less that 20% of the Medicare participating providers actually sell ostomy supplies, so that kind of search will lead to many dead ends.

Insurers other than Medicare also may have preferred providers. For some, these are just suggested suppliers, but for others they are the only providers recognized. Check with your insurance company before you start shopping for ostomy supplies. It is important to remember that not all the preferred providers will actually carry ostomy supplies or have just what you need. You may find yourself having to educate the staff of your insurer about what people with an ostomy need.

Don't be afraid to assert your rights under the terms of your plan. Please call the UOAA Advocacy Department at 800-826-0826 if you need help or e-mail advocacy@uoaa.org.

Finding local suppliers from trusted sources. If your stoma nurse hasn't already provided you with a list of local suppliers, now is the time to ask. Your surgeon's office might also have a list of suppliers, but it's a long shot. A local office of the American Cancer Society is another place to look.

Another excellent source for finding a local supplier is your local UOAA affiliated support group (see www.ostomy.org or call 800-826-0826). Many support groups have local ostomy supply advertisers in their newsletters.

Finding local suppliers in the phone book. You are most likely to find listings under "Medical Equipment and Supplies." If that fails, try "Durable Medical Equipment," "Home Medical Equipment" or "Surgical Equipment /Supplies." It is very unlikely that the phone book will have the category "ostomy" - though perhaps some do in very large cities.

The "Medical Equipment and Supplies" category will list some specialists in respiration products, mobility, etc. You might have to call a few before you find one that carries ostomy supplies. While you have them on the line, be sure to ask if they have the item you're looking for in stock. Another good question to ask is if they take Medicare or whatever insurance you have.

Local drugstores and the local outlets of national chains are very unlikely to carry ostomy supplies. If they do and wish to take on new customers, they will be listed with the other suppliers in the "Medical Equipment and Supplies" category.

If you are in a very small community and your phone book doesn't have any ostomy suppliers, think about going to your public library to look at phone books for the larger communities around you. Calling directory assistance for that larger community probably won't help unless you have the actual name of a supplier.

Finding local suppliers online. To continue your search for local suppliers, it's helpful to know that the Yellow Pages are available online: http://yellowbook.com/. Enter "medical supplies" in the "What are you looking for?" field, enter your location and then click "Find it."

Finding national/mail order suppliers from trusted sources. This magazine is the first place to look for a national ostomy supplier. Suppliers who advertise in The Phoenix know ostomy supplies and many have decades of experience meeting the needs of ostomates. They have decided to support the UOAA and ostomy community by advertising. Please show your appreciation by mentioning you saw their ad in The Phoenix magazine when you place an order.

Finding national/mail order suppliers online. A whole new world opens up if you are able to connect to the Internet. Sometimes that world can be a bit overwhelming and hard to navigate.

A great place to start is the UOAA web site. We are currently building an advertiser's page which will have many national suppliers. The UOAA discussion board is also another excellent source to ask questions and find a supplier

For these national search engines, it is best to use the term "ostomy supplies" so that the best answers appear at the top of the list. You will find that "sponsored" links are usually listed. These are links that someone has paid to appear when certain key words are entered in the search engine. Sponsored links will take you directly to an advertiser's web site where you can look for items, compare prices and order supplies online.

While it is not a conventional supplier, it is sometimes possible to buy supplies on eBay. You need to be careful to calculate the reserve and what you might intend to bid, in addition to the shipping responsibility, in order to determine if you are getting a reasonable deal by buying in this way. As this is written, there are 62 lots or items of a range of products available on that site.

Medicare Assignment

Medicare assignment is the act of the Medicare beneficiary signing an agreement that the reimbursement payment that would normally come to the beneficiary will instead go to the supplier that has provided goods or services. The assignment of benefits is very common, especially with physicians and other health providers, but is not often explained.

When discussing suppliers and ostomy supplies, we often speak of whether or not the supplier "accepts assignment." When a supplier accepts assignment, they are agreeing to accept the price set by Medicare for a particular product. This is critical in the ostomy marketplace because Medicare's payment for ostomy supplies is sometimes lower than the supplier's cost for providing them.

Home Health Care

It is becoming more common for someone who has just had ostomy surgery to receive the services of a home health agency in the first few weeks after discharge from the hospital. Since 2000, Medicare regulations have provided that during this period, the home health agency is responsible for providing ostomy supplies to those Medicare-eligible patients who need them. The agencies meet this in one of two ways (although we know that some agencies still fail to realize their responsibility):

Some have set up contracts with a local dealer or national mail-order company to supply what the patient needs. A benefit is that the supplier is more likely to have the range of products that includes what the patient needs. Plus, the patient can easily continue ordering from the supplier once the home health agency discharge has occurred.

Some home health agencies have chosen to supply the patient from items that they have in their own supply room. There may be serious drawbacks to this arrangement if the patient needs a special product that is not stocked, or if the patient needs more products than the agency is able or willing to provide in a timely manner. There is a well-known incidence of pouch failure and need to try other products during this post-operative period, which an agency formulary is not likely to be able to contend with effectively.

Even long-term ostomy patients who for some reason have to receive home health services must rely on the home health agency during that period of time to provide their supplies.

A survey of those who had a home health episode in the prior 3 years, conducted by UOA in late 2004, found that 21%, or a significant minority of Medicare beneficiaries who receive periods of home health care, experienced problems with regard to the provision of their ostomy supplies, either at the time of transitioning to and from home health or during the home care period. Many of those who responded said they felt so negatively affected by this experience that they would refuse home care services in the future because of the disruption it caused to their getting the supplies they needed.

For these reasons, the UOAA's position is to oppose the continuation of bundling ostomy supplies with the Medicare Part A home health benefit. We have proposed legislative changes to Congress, and hope that you will actively support this campaign and educate your own Congressman about it. See www.ostomy.org/advocacy for more details.