Elite Medical

Medicare Yesterday

Per month
10 pouches
10 wafers
1 paste
1 wipe

Closed pouches
difficult to get approved

Pastes and powders
are available to help with adhesion and leakage

Only 1 supply at a time.

Medicare Today

Per Month
20 wafers or barriers
20 drainable pouches
60 closed pouches

Pastes and powders are available to help with adhesion and leakage

Cohesive seals and strips help build a flat surface to keep skin dryer and avoid leakage.

May receive 3 months supply at a time.

Ostomy Update

March 10,2005

Some of you have had your ostomy -- colostomy, ileostomy, urostomy --for many years.  During those years your ostomy may have changed, the manufacturers have developed new products, and Medicare has changed.
Has your ostomy changed size?  Have you lost or put on weight?  If so your products may  not fit as well as they used to.  Is the skin surrounding your ostomy red and irritated?  Are you having leakage problems?  Are yourwafers not sticking as well as before.  If you can answer yes to any of these questions you might need to change the size or shape of your products.  You might also need to take better care of your skin.  There are new products on the market to help with all these considerations.
Medicare has also become more generous in quantities of products it will pay for.  Check the chart to find out the differences.  Medicare now sees the need for using a closed end pouch.  You could give up cleaning out your pouch completely!!
New products can make your life much more pleasant.  Do you have problems attaching your pouch and wafer.  Do you want a flatter look under your clothing?  Now there is the Esteem line of  products by Convatec.  With Esteem there is no longer a flange that needs to be attached.  Instead you can stick the pouch on the wafer with a new strong peel away adhesive packing.  It's as easy as putting a stamp on a letter!  This product is more expensive and Medicare is not covering the full cost of this product, but you could get this convenience for a very small additional outlay.  

Changes in product type can be made without a prescription, but changes in quantity will require a new prescription from your doctor.

New Products

Clipless tail closures
Cohesive seals
Cohesive strips
Filtered pouches
Convex inserts
Barriers you mold rather than cut.
Skin care cleansers, conditions and protectants.

Esteem Synergy Ostomy System

Wafers and pouches attach with adhesive rather than flange seals

Pouch drainable 1 and 2 piece

20 per month

Pouch drainable w/extended wear barrier

no established limit per month

Pouch urinary 1 and 2 piece

20 per month

Pouch urinary w/extended wear barrier

no established limit per month

Pouch closed

60 per month

Wafer w/flange (standard wear)

20 per month

Wafer w/flange w/extended wear barrier

no established limit per month

Skin barrier (standard)

20 per month

Extended-wear barrier

no established limit per month

Barrier paste

4 oz per month

Supplies Per Ostomy

The quantity of ostomy supplies needed by a patient is determined to a great extent by the type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma. There will be variation according to individual patient need. The table below (Elite will show one) lists the maximum number of items/units of service that are usually medically necessary. The actual quantity needed by a particular patient may be more or less than the amount listed….The medical necessity for use of a greater quantity of supplies than the amount listed must be well documented in the patient's records and may be requested by the DMERC.