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Thread: Colostomy logistics

  1. #1

    Colostomy logistics

    I'm trying to put together estimates of the costs of colostomy as part of an appeal with my Dad's insurance company. Would appreciate if those of you with colostomies could let me know about your experience.

    What kind of colostomy did you get, and why?

    How many appointments did you have with surgeons before getting surgery? Did you get more than one opinion?

    How many days were you in the hospital?

    Did you have any complications in the hospital?

    Did you go home after the hospital or did you go to rehab, and if rehab or a nursing home - for how long?

    Did any home health services go to your home after discharge (ex. RN, PT etc...)? For how long?

    How many follow-up appointments did you have with your surgeon, or any doctor, about managing your colostomy afterwards? How many with an osteomy nurse?

    Did you have MRI scans or CT scans before and after surgery? How many?

    What ongoing visits so you have with providers now specifically about it?

    Have you had any further complications of your colostomy over time?

    What supplies do you get now monthly? If you have any idea what insurance/Medicare pays for those, I would appreciate that info?

    Any ither costs for things that Medicare doesn't cover related to your colostomy?

    thanks for your help!

  2. #2
    Can't answer all your questions, but here are a few:

    For our clients having colostomies, they had usually one pre-operative visit with our colorectal surgeon, who saw them on referral from their SCI primary care physician. Most had what is called a diverting (not double barreled) colostomy in the transverse (sometimes descending) colon. Our surgeon did not also do a colectomy (removal of the distal bowel and rectum) unless the colostomy was being done for something like cancer, ulcerative colitis, or other bowel disease. That makes the surgery, and recovery, much easier.

    Some colostomies were done to divert stool from sacral or other posterior pelvic pressure ulcers, while others were done for obstructive megacolon or inability to manage the bowel any other way (traditional bowel care, enemas, or even ACE procedures).

    Usually a CT with oral contrast was done prior to the surgery. Rarely is an MRI indicated.

    Acute hospitalization was usually 3 days. Our surgeon wanted to see stool coming from the stoma before they would discharge the person, and sometimes there is a period of post-operative ileus that delays this longer...sometimes up to 5-7 days. During that time we also taught the patient and/or caregiver how to change the appliance, care for skin, etc. so they were independent in this by the time of discharge from the hospital.

    Don't see how you would justify an acute rehabilitation stay after a surgery such as this. You father can see the ostomy nurse as an outpatient for follow up teaching and problem solving. The surgeon would want to do a post-operative office visit (usually 2-3 weeks post-op). Some home health agencies also employ ostomy nurses if there is a reason that your father could not see one in a clinic setting. A nursing home is rarely needed for post-operative recovery for an uncomplicated colostomy.

    Medicare does cover colostomy supplies; primarily this is faceplates/wafers and bags (which together make up the "appliance"), and things like Stomadhesive paste. They may not pay for accessories such as deodorizers, skin protective wipes or cleansers, securement belts, or bag covers. Medicare Part B covers the amount of medically necessary ostomy supplies your doctor says you need, based on your condition. Medicare covers these supplies as prosthetic devices, with you responsible for 20% of the cost, after deductibles are met. https://www.medicare.gov/coverage/ostomy-supplies.html

    (KLD)

  3. #3
    Thank you KLD. It is useful to know what is typical.

    I was curious if some have had complications that might have required longer stays/rehab etc.. just to show the range of possible expenses for insurance companies. I suspected that rehab stays were not typical.

    I am trying to come up with some relative costs of colostomy vs. other new-ish neurogenic bowel treatments that are not currently covered by Medicare (such as Peristeen). Arguing relative cost effectiveness is sometimes helpful in getting insurance to consider coverage.

    For example, currently our local rehab hospital recommends Peristeen after typical oral/rectal meds fail, and just prior to considering colostomy. As a result, the direct cost comparison is reasonable.

  4. #4
    Interesting, as I have not seen any cases in my non-Veteran friends with SCI who have had colostomies (most under Medicare) where the procedure was not approved if recommended by the surgeon and primary care physician.

    (KLD)

  5. #5
    Sorry - I was unclear.

    Yes, you are right about Medicare coverage of colostomy. It's Peristeen that Medicare still wont cover. Now that most private insurances are covering Peristeen, 22 Medicaid programs cover it, and recently the VA is now covering it, we're going to try to appeal more aggressively for Medicare to cover it. And I thought I'd add some cost effectiveness into the argument we present.

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