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Diapers, insurance and hsa/fsa


Slomo

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Who loves dealing with insurance companies? And have you ever wondered if they will cover the cost of your diapers?

"Most" insurances will automatically deny coverage when first asked. Often stating they are not considered Durable Medical Equipment (DME), since they are not reusable. Except they actually do cover adult diapers, so that means they will provide them to you. And to get them to, you will need to file for an appeal. We'll, most usually do. Some people are just lucky to get them approved on the first try.

In every case I've seen, you first need to go to your doctor, then get a prescription for those diapers. If possible try and get the prescription to say exactly what diapers you want. Though this part will take a little research first. And the easiest way I've seen to do that is to call your insurance provider, and ask for a list of the adult diapers they cover. If they don't have a list, ask to be directed to their supplier for adult diapers. This is going to be a different number for a warehouse distribution facility. Ask them what brands of diapers they carry, and write them all down.  Either way, with list in hand go look up the different kinds they have until you find the best one. Now take that brand to your doctor for getting that prescription.

Of note here: Most insurances will only allow the cheapest and crappiest diapers out there. So expect the "best" might only be something like Tranquality ATN, or Seni (both of which are cloth backed disposables, and are barely functional as a diaper).  Alternatively, a very few companies will secretly allow for a "drop shipment". Meaning they will approve of other non-covered diapers, shipped by someone else (such as LL medical or North Shore Care), as long as that order doesn't exceed a certain price. As example, you can do this with the VA west of the Mississippi, but not VA east. You just need the prescription to say what diaper that is. And don't forget it includes the size too!

Whew, ok. From here your doctor's office should submit the claim on your behalf. If not, get a written script and take it to your insurance carrier in person. Give it two days if your doctor submits it, then proactively call your insurance company. Or ask to talk to someone if delivering it in person. Now, ask them to verify your claim and if they can send you the diapers you wanted (that were named on your script). Many will still try and switch it to a cheaper brand, so this step is necessary to prevent that.

And there you go. Just sit back and wait for those cheap but free diapers to show up at your house.  But also be aware, that shipment is usually not discrete. And now you know why most everyone just buys better diapers on their own- unless cost is a serious concern.

 

Which brings me to a Health Savings Account (HSA), or a Flexible Savings Account (FSA). You ask your employer to set this up for you, and they take out a certain amount of money from your paycheck- before taxes. They deposit this money into that account, which you can spend on government pre-approved items (there an online list). And yes the government includes adult diapers as an approved, tax free purchase with any HSA/FSA debit card. Note: there is no government requirement for disclosing why you may need diapers. You can get them regardless of that. However, be prepared as you may still need to disclose what you are purchasing to your employer or HSA/FSA banking holder.

After that you can make an online or in-store purchase with that debit card. Make sure you save all receipts too, as the banking card holder or IRS may ask for proof of all purchases on that card. And now you know why most everyone just buys diapers on their own.

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13 hours ago, Slomo said:

Which brings me to a Health Savings Account (HSA), or a Flexible Savings Account (FSA). You ask your employer to set this up for you, and they take out a certain amount of money from your paycheck- before taxes. They deposit this money into that account, which you can spend on government pre-approved items (there an online list). And yes the government includes adult diapers as an approved, tax free purchase with any HSA/FSA debit card. Note: there is no government requirement for disclosing why you may need diapers. You can get them regardless of that. However, be prepared as you may still need to disclose what you are purchasing to your employer or HSA/FSA banking holder.

After that you can make an online or in-store purchase with that debit card. Make sure you save all receipts too, as the banking card holder or IRS may ask for proof of all purchases on that card. And now you know why most everyone just buys diapers on their own.

@Slomo: This brings me to the "fun" I had when I started working for my current company.  I reviewed the "approved" list prior to setting my contribution to the FSA account for the first year, and it included "incontinence" supplies as a covered item.  So, with a doctor's prescription in hand (not necessarily required), I bought a set of cloth diapers and submitted the receipt (with documentation of need) requesting reimbursement for the diapers.  They came back and rejected it because they had a conflicting rule, where they listed diapers explicitly and not covered by this plan.  After filing a complaint on this I eventually won and got my reimbursement.  So, coverage is both based on IRS rules and what the company sets up for its acceptable list.  If I had gotten adult disposable "briefs" I wouldn't have had the issue.  : (

And I do believe if asked, you may need to show medical need for this type of item.

I haven't tried to get the diapers under my insurance plan....  I think the cloth diapers could be done under durable medical equipment on a low frequency.

Your mileage may vary....

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