It can feel intimidating to have a conversation with your doctor when you are asking for help getting essential your incontinence, ostomy, and wound care supplies. I am here to tell you it does not have to feel awkward or complicated. In fact, when you walk in prepared, it can be an easy and efficient appointment. Unfortunately, I have seen what happens when patients arrive for an appointment without the necessary information. The provider may write a prescription that is missing key details. This can lead to a medical supply company requesting clarification, making extra trips to the office, or waiting weeks for their supplies. Here are a few tips to help avoid those complications.
Do Your Research Before Your Appointment
The single most important piece of advice I can give you is this. Talk to your insurance company about what they cover and to know exactly what you want and need. Our providers may not be able to provide the specific brand, type, size, and quantity of supplies you use. They manage your diagnosis and are wonderful at that. But you are the expert on your daily supply routine. Bringing that knowledge in saves everyone time and ensures your prescription is right the first time.
Here is what you need to research and write down before your visit, organized by supply type.
Incontinence and Catheters
Identify the specific brand and product name you prefer, your size (typically small, medium, large, or extra-large based on waist or hip measurement), whether you use briefs with tabs, pull-up style underwear, pads, male guards, or underpads, and how many products you use per day. If you have not yet found a brand you prefer, you can call a medical supply company in advance and ask for samples. Many of them will provide free product samples before you place your order.
With catheters, it’s important to know the type (intermittent, indwelling, or external), the tip style (straight or coude), the size in French units, whether you need a latex-free or coated catheter, whether you use a closed system kit for infection prevention, and how many catheters you use per day or per week.
Ostomy
Know your ostomy type (colostomy, ileostomy, or urinary ostomy), your pouch system preference (one-piece or two-piece, drainable or closed-end), your wafer or skin barrier size, including the flange size and stoma opening size if applicable, the brand you use or prefer, and how often you change your pouching system. Your stoma size can be measured using a stoma measuring guide, which many ostomy supply companies provide for free.
Wound Care
Have your wound care nurse’s or specialist’s contact information available and bring any written wound care instructions you have received. Know the type of dressing being used (for example, foam, hydrocolloid, alginate, or antimicrobial) and how frequently dressing changes are performed. Your wound care provider can also send a note to your primary care provider outlining the supplies needed if you ask them to.
How to Bring It Up With Your Provider
Its ok if you feel awkward about asking your doctor for a prescription for supplies. Remember, you are entitled to the best possible care, which includes help with obtaining medical supplies. I want you to let go of that worry entirely, and here is some language you can use to start the conversation: “For this condition, it requires me to use certain medical supplies on a regular basis, and I have learned that my insurance may cover them with a prescription. I would like to ask you to write one so I can submit it through my insurance and stop paying out of pocket.” Most providers will respond warmly and immediately.
A good strategy is to call or message your provider’s office or send a message via your electronic health record a few days before your appointment to give them a heads-up. Ask the nurse or medical assistant to make a note in your chart regarding a prescription for medical supplies during your visit. That way, your provider arrives at your appointment already thinking about it, and it does not feel like a last-minute add-on at the end of a busy visit.
Details to Include in Your Conversation
During the appointment, be specific about how your supplies connect to your diagnosed condition. Your provider needs to tie the supplies to a documented medical condition in your chart. For example, if you have a neurogenic bladder related to multiple sclerosis and require intermittent catheterization, say so explicitly. If you have a chronic venous leg ulcer being managed by a wound care specialist and need specific dressings at home between visits, explain that connection. If you had an ileostomy after colorectal cancer surgery and need ostomy supplies, your provider should already have this in your records, and your role is to bring it to the forefront and make sure the documentation reflects your current needs.
What Your Provider Must Include on the Prescription
A prescription for medical supplies is different from a prescription for a medication you pick up at a pharmacy. It requires specific elements to be usable by a medical supply company and accepted by your insurer. Think of this as your checklist before you leave the appointment.
A basic checklist that your prescription should include is:
- Your full name
- date of birth
- Provider’s name
- National Provider Identifier number (NPI)
- Provider’s signature
- Date the prescription was written
- Relevant diagnosis, including the ICD-10 code
- Specific type of supply ordered with enough detail to identify the product. For example include intermittent catheter, straight tip, 14 French, latex-free, closed system kit.
- Quantity needed per month or per the defined supply period
- In some cases, the specific brand or manufacturer reference number.
Additional Requirements for Ostomy and Wound Care Supplies
For ostomy supplies, some insurance plans, including Medicare, require a face-to-face encounter within the past 6 months. To ensure quantity aligns with your medical record, your provider needs to include the clinical justification for your specific supply needs. This is especially true if you require a quantity above Medicare’s standard monthly allowable.
For wound care supplies, documentation in your health records must reflect the wound type, wound location, and clinical justification for each dressing type ordered.
For incontinence products covered by Medicaid managed care plans, most states require that the prescription specify the product type, size, and daily quantity, as well as the diagnosis. Many Medicaid programs also require periodic reauthorization, so keep your provider informed when your condition or supply needs change.
Before You Leave the Office
Before you walk out the door, be sure to confirm a few things.
- Whether the prescription will be faxed directly to your chosen medical supply company or you will receive a paper copy to submit yourself.
- When the prescription will be available, some offices process same day, and others may take a few days.
- If you already know which medical supply company you would like to use, give the office their name and fax number so the prescription can be sent directly to them
Taking these small steps before you leave will hopefully help smooth the transition to the actual ordering process and avoid potential communication gaps that can delay your supplies by days or even weeks.
You Already Know More Than You Think
One of the most empowering things I can tell any patient or caregiver is this: you already have most of the information your provider needs. You live with this condition every day. You know what supplies work for you, how often you use them, and what happens when you do not have them. That knowledge is valuable, and bringing it to the appointment makes the entire process faster and more effective.
Remember, when trying to get your medical insurance to cover ostomy, incontinence, or wound care supplies, it is always important to start by verifying what your plan may cover before having your provider write the prescription. The next article in this series will walk you through exactly what happens after your provider writes the prescription, including how to choose a medical supply company, how the insurance submission process works step by step, and which Medicare-approved supply companies are available to you nationwide.