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Thread: Insurance and bowel care

  1. #1

    Insurance and bowel care

    Just wanted to know if anyone has any experience with trying to get insurance to pay for someone to perform morning bowel care? Please let me know your experience or advice?

    Thank you
    J

  2. #2
    What type of insurance?? Are you talking about having it done by a nurse from a home health agency? By a family member? By a personal care attendant (PCA)?

    Medicare will not cover it as it is not seen as "skilled" nursing care. Workers comp and the VA will pay for it, but most other insurances will not as they tend to follow Medicare guidelines in this area.

    (KLD)
    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.

  3. #3
    Thank you SCI nurse,

    private insurance through the company i work for. It seems like a case could be made that it is medically necessary and insurance could pay for having it done by nurse/assistant/PCA. Just trying to stay active/healthy/productive and ease some of the financial burden of living with SCI. Does that make sense?

  4. #4
    Definitely makes sense, and you certainly can try, but historically the situation with insurance for this type of care is as I described above. Keep in mind that in many states, if you are attempting to use a HHA (home health agency) for bowel care, a PCA or HHA (home health aide) will not be allowed to do this; so an RN or LVN would be required.

    (KLD)
    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.

  5. #5
    Again, thank you for the response SCI-Nurse. I know dealing with the insurance co can be difficult. What would the 1st step be? Putting your case together then presenting it? Seeking someone that has experience with this? Is there any resource to help someone to navigate this? I'm just trying to figure out the 1st couple of initial steps

  6. #6
    You probably need to 1) get a physician's order and 2) talk to you HR people about your policy coverage and ask them to pursue whether or not this would be covered for you.

    (KLD)
    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.

  7. #7
    I hate to dig up an old thread, but I can't help but to point out the irony in these policies.


    For a while now, most states haven't allowed a HHA/CNA from an agency to help with bowel care, a nurse is required. At the same time, Medicare/insurance won't pay for bowel care because it's not skilled care. So the skills and certification of a nurse are required, but it's not skilled care?


    *facepalm*

  8. #8
    A good example of how state (scope of practice) and federal (Medicare) laws and regulations so often don't jibe. (and nurses are licensed, not certified. There is a difference.)

    (KLD)
    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.

  9. #9
    Senior Member
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    Quote Originally Posted by JDun333 View Post
    Just wanted to know if anyone has any experience with trying to get insurance to pay for someone to perform morning bowel care? Please let me know your experience or advice?

    Thank you
    J
    seriously if you require bowel care go with a colonosty its easy and anyone can change it to

  10. #10
    Quote Originally Posted by vjls View Post
    seriously if you require bowel care go with a colonosty its easy and anyone can change it to
    colonasty*

    FTFY

    jk, I'm fully aware that a colostomy might be an easier approach down the road.

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