Home Health Care Services and Ostomy Supplies

You may wonder how does a patient get Ostomy supplies covered when on service with a Home Care Agency. Depending on the patient's primary insurance, the patient may be required to either obtain supplies through a medical supplier or through the home care agency. This is based on how services are authorized for a patient's episode of care. Sometimes all supplies and visits are paid as a single sum to an agency or sometimes each part of care is authorized on its own. Please review the following scenarios to help understand the patient's current options.
 
Medicare
If the patient's primary insurance is Medicare, the home care agency is responsible for supplying these items to their patients. They receive a lump sum that the are to budget over the episode of care which includes supplying ostomy supplies. So if the patient has home care services, they need to contact their nurse or case manager regarding supplies. Medicare will not pay an outside supplier during an episode of care. However, keep VPC in mind as a local provider when the patient is discharged from Home Care. 
 
Aspire Health Plan - Non-Commercial/Medicare
If the patient's primary insurance is Aspire Health Plan, the home care agency is generally responsible for supplying these items to their patients. They typically receive a lump sum that the are to budget over the episode of care which includes supplying ostomy supplies. So if the patient has home care services, they should contact their home care nurse or case manager regarding supplies. Aspire Health Plan will not pay an outside supplier during an episode of care if supplies are included as part of the episode of care. Do not hesitate to contact us to check for you if it is uncertain. Keep VPC in mind as a local provider when the patient is discharged from Home Care. 
 
Medi-Cal
If the patient's primary insurance is Medi-Cal, the patient is allowed to use a medical supplier such as VPC to obtain their ostomy supplies while on service with a home care agency. Typically each part of care is authorized independently, thus while the home care agency gets approval for patient home visits the medical supplier can obtain approval to supply the patients ostomy supplies. 
 
Private Insurance
If the patient's primary insurance is a private insurance, the patient should contact their insurance carrier to find out how supplies are covered during a home health episode. Some policies are like Medicare where the agency negotiated to provide all aspects of ones care including supplies while others are like Medi-Cal and are treated independently whereby the patient needs to find an in-network provider. **Unfortunately, VPC is out-of-network as the private insurance carriers claim there is too many providers in our area. 
 
 
Some bad news for Monterey County
 
Coastal TPA/Commercial Aspire/Blue Cross
For patients that have Coastal TPA or Commercial Aspire, they will need to find an in-network provider. Please contact Coastal TPA whom will hopefully help. Coastal TPA uses Anthem Blue Cross' network whom does not wish to contract with new providers. 

Medicare and Incontinence

Medicare DOES NOT cover incontinence supplies. Unfortunately, they claim items are not covered because "they are not a prosthetic device nor are required for the effective use of a prosthetic device"  (LCD A25377)
 
You may have to purchase these supplies privately if your secondary is not Medi-Cal or VA.

Medi-Cal and Incontinence

Medi-Cal will cover incontinence care items on a monthly basis. The doctor 1) needs to complete a CMN or make a prescription detailing the patients needs and 2) provide medical records showing that the patient is incontinent either by note or diagnosis. Due to the fraud in the industry a prescription is not sufficient by itself for the insurance to cover an item or items. The prescription authorizes what is needed while the doctors medical records (ie visit notes/soap notes/patient chart...) prove medical need and context justifying coverage. 
 
Medi-Cal covers the following items:
    Diapers/tabbed briefs
    Adult Pull-ups
    Underpads
    Inserts
    Cream/Wash
    Gloves *
    Wipes*
 
* Gloves and wipes may be covered with special authorization. VPC will submit a request for approval (TAR) once adequate documentation received for processing (ie CMN and Medical Notes).

Custom Orders

Items not found on our website or not stocked may still be ordered. You will need to contact Customer Service and let them know what you are looking for so that they can research availability. Depending on the item, special orders can take up to 5 days to receive and there may be shipping fee depending on the vendor but VPC will let you know.  If the item is over $50, you may have to prepay for the item. You may reach Customer Service by phone, fax, email, or through our online chat. Thank you.
 
Contact Specifics
(P) 831-757-6657
(F) 831-757-3918
customerservice@vpcare.com

Medi-Cal Covered Bath Equipment

Medi-Cal Covered Bath Equipment Options

Toilet Safety Options

Raised Toilet Seat (TSR) - Has 3 options: Front Locking / Round Insert / Elongated Insert
Toilet Safety Frame
Commode - Medi-Cal only patients

Bathtub Safety Options

Bath Stool
Bath Seat - Has 2 options: With back / Without Back
Transfer Bench

Bathroom Safety Bars

Wall Grab Bars- Has 3 sizes: 12in / 16in / 18in
Vertical Tub Bar

*Most equipment, allowed 1 every 5 years. Except Wall Grab Bars, allowed 2 every 5 years.