www.incontinentsupport.org

Has anyone been able to appeal and win a denial for their insurance company to cover the cost of diapers? If so, would you be able to tell me what claim code they were filed under and the final reason why your insurance company accepted it? Even a PM would be great!

I have Tricare Prime for disabled military retirees. I know I could get my diapers through the VA, but I have not been to the VA in almost 20 years. I know I would need to re-establish my care with them to even start pursuing getting them through the VA. Instead, I get all of my care through the military base network hospitals, and of course there is the point that I should have been denied in the first place. In the last few months I've gotten a new doctor (stupid rotations), but he has been willing to spend some time trying to get my diapers covered for me via the military insurance.

My doc had submitted the initial request & as expected it was denied. I then personally had to submit an appeal, and included a doctors prescription. Incidentally I asked for Confidry 24/7 from xpmedical.com since I know Gary already deals with insurance company claims via the VA and Medicare. I also included a signed official letter from my doctor stating they were medically necessary, and a letter from me stating why I needed them and believe they should be accepted.

Well, I just got a letter back from my Tricare insurance and they were denied again for two main reasons. 1) they filed my diapers under "incontinence product- incontinence pad", which they deem a "convenience item" and is of course incorrect anyways. 2) They denied them because their bylaws state anything for childcare- specifically listing diapers- is not covered. Obviously this too is wrong as I'm not a child.

So, long story short, I'm looking for the government code and listing which adult diapers would be filed under. This way I can point to them I was denied for the wrong reasons and what it should be properly submitted under. I'm also hoping to give an example for why they should be approved based on a past example or two- if possible.

Any help would be appreciated. Thanks all.

Unreal. How are incontinence pads or any kind a "convenience item"? So ridiculous. Have you tried talking to then on the phone...ask for a manager.

This is just a guess, but if you think about it a true pad should not be needed so long as you have actual diapers that work properly. (and ideally a diaper cover too). And if your diaper does fail then at the very least you can still live on with cleaning your chair or pants. In this regard a pad really is a convenience item.

I'm also thinking this is just coming back to some insurance adjuster that is embarrassed to call them diapers or too stupid to realise a pad and a diaper are actually two very different things. Hence why they filed it under the wrong item code. And why I need to do their job to point out what the correct one is.

And yes I did talk to someone on the phone. They just said why it was denied and that I have a right to file a second appeal. Lots of help there. Not.

i called xp and they said they dont deal with insurance companies

I've heard from others (even on this site) that they were able to fight their own insurance company and get a supply approved to be delivered from xp medical. I'm kind of just trying to do the same, but it's a bummer nobody else seems to be able to help. Oh well, not the first time I seem to have pioneered- and recorded- something in the old incontinence department (even if it's been done before).

justej wrote:i called xp and they said they dont deal with insurance companies

I find it odd that XP Medical or any of the larger supply houses don't work with with or push insurance companies to provide coverage. They would have all the statistics of ages, gender and type of product used to advise insurance companies of how large this problem is.

Well I do know that xp did/does work with insurance companies at least a little. At a minimum they are "approved" by a few insurance companies- which no company gets that without at least talking in a few insurance reps.