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Thread: Where to get pristeen in California

  1. #21
    Quote Originally Posted by emanshiu View Post
    thank yo. Did all of you do the evaluation and training? It really is running through a lot fo hoops and costs just to try this. It seems almost cheaper to buy the system and try it. Thoughts?
    The whole evaluation and training thing is just a big CYA if insurance is covering it. There's no way you're going to hurt yourself unless you do something incredibly stupid. I've looked at all these units now and still think the Irypump is the best: smallest, sleekest, automatic pump for ease of use, less parts and tubes and bags, cheapest in the long run.

    I would not be worried one bit about it potentially not working. Other than the Peristeen catheters that I've seen people hate, it looks like everyone who starts irrigating never goes back to previous methods of bowel care.

    If you buy an Irypump and decide you don't want it, I'll buy it off of you to have a second one at my aunt and uncle's place where I visit often. But I know you'll keep it.

  2. #22
    Quote Originally Posted by Davey View Post
    I just bought the unit, watched a few videos and tried it. Been working great for about two years now.
    Where did you buy the unit?

  3. #23
    Quote Originally Posted by paraparajumper View Post
    The whole evaluation and training thing is just a big CYA if insurance is covering it. There's no way you're going to hurt yourself unless you do something incredibly stupid. I've looked at all these units now and still think the Irypump is the best: smallest, sleekest, automatic pump for ease of use, less parts and tubes and bags, cheapest in the long run.

    I would not be worried one bit about it potentially not working. Other than the Peristeen catheters that I've seen people hate, it looks like everyone who starts irrigating never goes back to previous methods of bowel care.

    If you buy an Irypump and decide you don't want it, I'll buy it off of you to have a second one at my aunt and uncle's place where I visit often. But I know you'll keep it.
    According to the SCI nurses, it is possible to exacerbate a tendency to mega colon or create a mega colon if too much liquid is instilled into the rectal vault too quickly or forcefully. Just sayin'...need to be careful...all of us are different and may have a different reaction/experience than yours.

  4. #24
    Quote Originally Posted by gjnl View Post
    According to the SCI nurses, it is possible to exacerbate a tendency to mega colon or create a mega colon if too much liquid is instilled into the rectal vault too quickly or forcefully. Just sayin'...need to be careful...all of us are different and may have a different reaction/experience than yours.
    Like I said, the only way you're going to do damage to yourself is if you instill an ungodly amount of water. Since "megacolon" started getting thrown around a few pages back, I've been doing my research and have come across absolutely nothing that shows colonic irrigation has anything to do with causing megacolon! Period. It's actually prescribed to TREAT megacolon. Megacolon is dilation of the large intestines, and often results secondary to paralysis (SCI) and decreased peristaltic movements. You'd probably get megacolon due to your SCI, not because of the irrigation you perform as your bowel program.

    If you're instilling so much water into your intestines that you're stretching them to the point of rupture or permanent damage, again, that is what I referred to as doing "something incredibly stupid." Putting in 500-1000mL of water at a slow and steady pace is not going to hurt you, and you don't need a medical professional to teach you how to do it (my opinion).

    If anyone can find me information showing irrigation causes megacolon, please link me. SCI-Nurse, if you have anything to provide, that'd be greatly appreciated. Everything I can find says the complete and 100% opposite, that irrigating the bowels is treatment for it.

  5. #25
    Medicare still isn't covering it. Some Medicaid plans cover it, the VA now covers it, and many private insurances cover it.

    I bought supplies cheapest from some Canada, and sometimes off eBay.

  6. #26
    Quote Originally Posted by hlh View Post
    Medicare still isn't covering it. Some Medicaid plans cover it, the VA now covers it, and many private insurances cover it.

    I bought supplies cheapest from some Canada, and sometimes off eBay.
    From what I have read, Medicare does cover the initial purchase of the Peristeen equipment and supplies that come with the original issue to the patient. As it is with Medicare, it covers 80% of that inital cost.

    Depending on the kind of supplement you have, your supplement may pay the entire remainder 20% or whatever portion your supplement covers over Medicare reimbursement, if you have a supplemental policy.

    The thing that Medicare does not pay for is any of the on going needed disposables needed after the original purchase, i.e., catheters, tubing, bags.

    See my post with quotes from various sources at post 14 above.

  7. #27
    Quote Originally Posted by paraparajumper View Post
    Like I said, the only way you're going to do damage to yourself is if you instill an ungodly amount of water. Since "megacolon" started getting thrown around a few pages back, I've been doing my research and have come across absolutely nothing that shows colonic irrigation has anything to do with causing megacolon! Period. It's actually prescribed to TREAT megacolon. Megacolon is dilation of the large intestines, and often results secondary to paralysis (SCI) and decreased peristaltic movements. You'd probably get megacolon due to your SCI, not because of the irrigation you perform as your bowel program.

    If you're instilling so much water into your intestines that you're stretching them to the point of rupture or permanent damage, again, that is what I referred to as doing "something incredibly stupid." Putting in 500-1000mL of water at a slow and steady pace is not going to hurt you, and you don't need a medical professional to teach you how to do it (my opinion).

    If anyone can find me information showing irrigation causes megacolon, please link me. SCI-Nurse, if you have anything to provide, that'd be greatly appreciated. Everything I can find says the complete and 100% opposite, that irrigating the bowels is treatment for it.
    It is always surprising to me how differently people interpret instructions. Many people operate on the premise that if a little is good, a lot more is better. I only posted my comments as a caution, not as a negative to the entire process.

    That said, the SCI nurses on this site have stated several times that they have seen and caution that mega colon may occur with the use of water enemas. I am only going on what they have said based upon their vast experience of many years combined, with a broad population of patients. Maybe that doesn't account for much with you...but erring on the side of conservative use and caution makes sense to me.

    I am wholly on board with trying and using these water enema systems in those of us who are long term spinal cord injured and whose options are running out with products like Magic Bullets and Eneeez not working for us as well as they once did, as in my case 35+ years post injury.

  8. #28
    Quote Originally Posted by gjnl View Post
    From what I have read, Medicare does cover the initial purchase of the Peristeen equipment and supplies that come with the original issue to the patient. As it is with Medicare, it covers 80% of that inital cost.

    Depending on the kind of supplement you have, your supplement may pay the entire remainder 20% or whatever portion your supplement covers over Medicare reimbursement, if you have a supplemental policy.

    The thing that Medicare does not pay for is any of the on going needed disposables needed after the original purchase, i.e., catheters, tubing, bags.

    See my post with quotes from various sources at post 14 above.

    Trust me on this one gjnl. Medicare does not cover it. I just want to state this clearly so that people are not misled.

    You even gave the evidence of this from Medicare coverage determination literature.

    A4459 – MANUAL PUMP ENEMA SYSTEM, INCLUDES BALLOON, CATHETER AND ALL ACCESSORIES, REUSABLE, ANY TYPE
    There is no Medicare benefit for this device; therefore, claims for code A4459 will be denied as non-covered (no Medicare benefit).

    Medicare does agree that the Peristeen system is not identical to a simple enema and created a unique procedure code for it, but there is "no Medicare benefit for this device". No procedure code exists for the replacement supplies.

    My father has Medicare, and I just argued in front of a judge trying to get coverage for Peristeen, and have already gone through 3 levels of appeals. Medicare does not cover it, and no supplier will provide it to you when they hear when you are on Medicare because they know it wont be reimbursed. And you cannot buy it on your own from a Canadian or US supplier and try to submit it for coverage because Medicare does not allow claims to be submitted by non-Medicare suppliers or directly from patients (except in rare cases) anyway.

    Coloplast is trying to appeal to Medicare, again, for coverage since so many insurances now cover it in the US, and it has been established as a standard of care and as well as being cost effective in europe for severe neurogenic bowel.

    Since Medicare cannot argue that the medical necessity has not been established for Peristeen as their reason for denial, their reason for denial is simply that no category within DME currently exists that would be applied to the device so their computers can process a claim. It does not fit their strict and arbitrary definition of DME as lasting for more than 3 years, and it does not fit into one of their other subcategories of medical supplies/equipment that are considered as exceptions to this arbitrary definition (ex. it is not a prosthetic device in their opinion, it is not oxygen supplies, it is not diabetic shoes etc....). They either have to re-consider the argument that it does serve as a prosthetic device, similar to urinary catheters, or create a unique DME coverage category for it.

    I may continue my appeals based on the cost-effectiveness argument, but changing Medicare coverage is like moving a mountain.

    And honestly, now that I am reading so much about alternatives to Peristeen, we may consider using those instead. Coloplast has not been very helpful or pro-active in assisting us with this process, and I have lost interest in working so hard on appealing something that would benefit an unhelpful company a lot but maybe not those with SCI.... since there are cheaper and usable other options available.

  9. #29
    There are other advantages to being educated about a new system. Each individual comes into a situation with certain expectations. And while you may not think that you need the education, I guess my response would be, what does it hurt. Besides mega colon, which I still have concerns about from my education, you need to make sure that you are placing the catheter correctly. While injuring the intestinal wall seems difficult to do, it is not. I also have concerns about the adage "if a little works well, why not use a little more and it will work better." While that may be true in some things, (like in my opinion garlic or cinnamon use), it is not so with some devices.

    I am certainly not against trying new things and I do believe that it is important to do so, I just encourage a little caution and education until you feel comfortable doing it.

    ckf
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  10. #30
    Quote Originally Posted by SCI-Nurse View Post
    Besides mega colon, which I still have concerns about from my education, you need to make sure that you are placing the catheter correctly.
    Do you have any information I can read that links megacolon to irrigation? I literally cannot find a single thing.

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