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Thread: How can I get catheters through medicaid?

  1. #1

    How can I get catheters through medicaid?

    Okay this is waaaay harder than it should be.

    From what I can gather now that I visited a doctor and got a prescription for catheters, now I have to go get a home care nurse through medicaid just so medicaid will pay for them??? WTF is that? I thought medicaid was running low on money, why would they make me get a nurse that I dont need just so they will pay for catheters?

    Help me please, I've got no idea how to get what I need. It is NC medicaid by the way. Is there anyway that I can just go to a pharmacy and have them bill medicaid for the catheters without having to go through a home health agency?

  2. #2
    Every state Medicaid program is different. If you are getting home health skilled nursing, then your supplies must be provided by the agency. Whether or not they will cover catheters if you are not getting home health nursing will vary with the state. You need to contact the state Medicaid program directly, or seek assistance from your local ILC to get clarification on this:

    http://www.dhhs.state.nc.us/dma/

    (KLD)

  3. #3
    Thanks for taking the time to get me the link KLD, but I've already called everyone even remotely associated with that website. They're not really much help. The closest I've gotten is some 800 number where they tell me that I can get my supplies at a home health place (whatever that is), but the home health places will not just give me my supplies, I have to be registered with them as a patient (or whatever it is that they do). I think it is a colossal waste of time and money for them to send me a nurse every week, just so I can get supplies paid for by medicaid, but I guess I dont get to make the rules. (and there must be some rule that the rules are not allowed to make sense). I would just prefer not to have some nurse all up in my business, but it seems unavoidable.

  4. #4
    Are you sure they mean a home health nursing agency, or perhaps just a Medicaid certified home health supply company such as Uromed? Perhaps someone else from your state who is on these forums can clarify. Did you try posting this question on the Southeast States forum?

    Have you spoken to a benefits counselor at your local ILC? Called a social worker or discharge planner at your closest in-state SCI rehab center?

    (KLD)

  5. #5
    I did call an SCI rehab center (I went to one out of state) and they didn't have anything for me, they did not even know where an out of state patient could purchase catheters. Social workers are extremely hard to get a hold of at the local DSS and after several days of calling they really dont know where to get catheters. The doctor had no idea of a place that even sold them, much less one that would accept medicaid, but he did give me a prescription so I can go buy them (which I guess is good if I get really desperate). I havent actually talked to anyone in independent living (i think that is what you mean by ILC right?), but I do need to do that anyway, so I will pursue that this week.

    It seems like everyone expects me to have a nurse or aid to help me do everything. Even at the local college, they told me that they could not accomodate my toilet equipment if I didnt have a nurse to help me (they wanted me to pay a non-refundable deposit and then ask the person who would be my roomate if it was okay to have my toilet equipment there... he had it "easy" as he was a quad and had a nurse to come and help him each day). At the doctors office they kept asking me who was helping me with my care, like someone in a wheelchair isnt capable of taking care of themselves. I might get a nurse just for the convenience of it. It just seems like such a waste of resources that could be used to help sick people. For god's sake all I want is a few supplies so I can piss, but if that means I have to get the state to pay for a nurse to come by once a week and bring my supplies, I guess that's just the way it is.

    I will be sure to throw up a post in the regional forum, allthough it seems to me that it doesnt get used too much.

  6. #6
    Oh yeah, I forgot, I am sure that they meant a home health place that sends nurses out to you. Both the medicaid hotline and local pharmacies said the same thing and referred me to the same type of companies.

    I got a hold of a pharmacy and they told me that they did sell catheters, but they could only bill medicaid through a home health company. So I thought that the home health company was a store or something that could sell them to me. They gave me the number and I called them and they said that they were only allowed to distribute supplies to people who were enrolled with them (meaning having a nurse/aid visit them in their home). I got the exact same thing when I called the medicaid hotline... no one knows how you can get supplies unless you have a nurse. But over the course of the day at least 4 different people told me that medicaid covers EVERYTHING, I even had a home health nurse who was bringing a patient to the same doctors office as me tell me that I should enroll with her company so that she could help me get all kinds of things (she was telling me all about how I should get a power chair and have her drive me to the doctor and whatnot) its a shame how much money the system wastes.

    okay I am done ranting, just frustrated.

  7. #7
    I'll tell you what to try.

    Call CCS Medical.
    https://www.ccsmed.com/english/hcp/products/urology.asp

    Tell them your situation that you need an ongoing monthly supply of catheters and what your insurance is (Medicaid). Also no pharmacies in your area provide them. They will probably take your info along with who your doctor is etc. They will need that script too. CCS Medical take care of all the insurance forms and you get your monthly supply shipped to you.

    That was my experience with them. In two different states that I've lived in post sci I haven't been able to find a pharmacy that will get me catheters. CCS are out of state, but were still able to bill my insurance and they send me catheters every month. They even call in advance to make sure I'm ready for them. Hope this helps. They are based out of Georgia I believe.
    Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

  8. #8
    Senior Member mikek's Avatar
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    Call Uromed. They can answer any question.

  9. #9
    ***UPDATE***

    okay I think I worked it out. I havent actually received any supplies yet, but I think I found someone who is going to ship them to me.

    Just for anyone else with NC medicaid who finds this thread, this is apparently what you have to do.

    I called medicaid and got the number of a home health agency. Called the home health agency and they tell me like usual that if you dont have in home nursing care then they will not let you get your supplies from medicaid thru them. Then I asked to talk to the manager and told them that their contract with medicaid says that they have to cover people who do not have in home nursing care (someone from medicaid told me that this is one of the provisions). As soon as I got the manager on the phone and told her that, they immediately switched modes and asked me to just fax in a prescription and they will ship the supplies to my door! Yay only 6 months to figure it out .

    Anyway apparently what is happening is these home health agencies used to send out nurses to your home to verify that you really need catheters and whatnot (how a nurse is qualified to make a better decision on that than the doctor who writes the prescription for the supplies beats me). Well when gas prices went up there was a shortage of nurses willing to go on these in home assessments, so the companies just started telling people that they would not cover them if they didnt require in home nursing. According to the medicaid phone lady I talked to, this is a big problem in the past few months and medicaid is exploring legal recourses against these companies who are violating their medicaid contract by denying supplies to people that medicaid requires them to cover. Its all very confusing, but I think I finally worked it out.

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