“Wait — you mean our pull-ups could be covered by Medicaid?”
Every day, it’s a statement we hear from families just like yours. Most people just aren’t aware that their child’s incontinence supplies can be covered by Medicaid. Or if they are aware, they’re not sure where to start, or how to navigate the process.
No matter which category you fall into, you’re in the right place. In this blog, we’re going to walk you through the insurance coverage process, some of the bumps you might run into, and what we do at TMS to help families get over those bumps and get approved faster.
Ready? Let’s get started.
Let’s start with how things should work. The process usually starts in your doctor’s office.
| After your child is diagnosed with an issue requiring pediatric incontinence supplies, your doctor or nurse will usually refer you to a company like Total Medical Supply. | |
| The doctor’s office will fax a prescription for the supplies, such as pull-ups or diapers, directly to the supply company. This prescription will include details like the type of product needed and the frequency of use. | |
| After they receive the prescription, the supply company will verify your insurance coverage, particularly Medicaid. |
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| Once that’s finished, you’ll receive a call from the supply company (in this case, TMS) to discuss the products, sizes, and brands available. | |
| A representative will ensure they meet the child’s needs (pull-ups, for example, might not make sense for a child without motor skill control, who isn’t changing their own diaper). |
Related Reading: A Parent’s Guide to Ordering Pediatric Incontinence Supplies
Now that we know how things should go, let’s look at where things could go wrong and how TMS ensures they don’t.
One of the first hurdles you might face is with the prescription itself. Medicaid requires specific details on the prescription, including the doctor’s signature and precise information about the supplies (sizes, amounts, etc.).
If any of the required information is missing, you’ll face delays.
To avoid this, we double-check the forms to make sure everything is there before we submit them. We verify the doctor’s signature, the specific supplies needed, and any other essential information.
If any details are missing, we’ll contact your doctor’s office to correct the issue. That helps us stop delays before they happen so your child never has to wait for the diapers they need.
Every state has its own Medicaid requirements for covering supplies like diapers and wipes.
Arkansas Medicaid and Texas Medicaid, our main coverage areas, have different documentation and coverage requirements. (Note: Some states may cover only a portion of the necessary supplies. Arkansas Medicaid, for example, will cover only three to four changes a day — compared to eight in Texas.)
It can be hard to know exactly what you need to provide, especially if you’ve recently moved to a new state or have never navigated the Medicaid process before. Luckily, when you work with TMS, we gather the necessary documentation and ensure it’s all filled out correctly, so you don’t have to.
Here’s a look at what each state requires:
How Arkansas and Texas Differ: |
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Arkansas Medicaid:
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Texas Medicaid:
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Overwhelmed? Want a real person to walk you through how all this works?
No problem! Get in touch, and one of our friendly TMS reps will be more than happy to answer all your questions.
If your child’s PCP changes, it can complicate the process. Medicaid is strict about who can sign off on these prescriptions. Only the PCP they have on record for your child can do it. So, if you change PCPs, make sure to let us know immediately. We’ll update this information with your Medicaid provider to avoid delivery delays.
Medicaid won’t cover a product you don’t have a current prescription for. So, if yours expires, you’ll need to visit the doctor to renew it. This usually happens every six months. But don’t worry. We’ll reach out to remind you that your prescription is expiring so you can make the necessary doctor’s appointments. That way, you won’t have to worry about paying out of pocket for diapers while you wait to see the doctor.
Ready to start the process? Here’s a checklist for you or your care team to keep handy. Ticking off these boxes will help ensure your child gets the supplies he needs when he needs them.
We get it. No one wants their neighbors to know that their older child wears diapers. So, you don’t need a giant box labeled “Diapers” in bold lettering sitting on your front porch until you get home. At TMS, we believe in discreet deliveries. So, we do whatever is necessary to keep what’s inside the box a mystery to anyone but you. We might put them inside another unmarked box, tape over the label on the current box, or repackage the entire order to disguise its contents. And when we add our own shipping labels on top, they’ll contain only necessary information, like your name and address, so even the post office employees won’t know what’s inside.
This definitely isn’t our first rodeo. We’ve helped thousands of parents like you get supplies covered under Medicaid. And along the way, we’ve picked up a few helpful tips.
Here are some that might help:
This process will throw a lot of information at you (like prescription renewal dates, size specifications, and information about your child’s condition, just to name a few). Write it all down. Keep a notebook or calendar with doctor’s appointments, prescriptions, expiration dates, notes from appointments, and everything else you need to keep track of. That way, you won’t have to hunt down the information you need. And don’t worry: We’ll keep track of all that information as well, and we’ll call you to remind you when something is expiring or we need more information to get your order shipped.
An important note about those calls from us: You won’t want to miss them. It could delay your next shipment. So, save our number in your phone so you don’t dismiss an important call from us as spam.
You’ve got a lot on your plate. So, it can be hard to keep track of a doctor’s appointment or when a prescription is expiring. But missing these dates can mean long delays in getting your supplies. So put reminders in your phone so you never miss an important date.
If you live in Arkansas, Medicaid probably won’t cover all the diapers your child needs. So, plan for other ways to pick up the slack, whether it’s supplemental coverage or clipping coupons to save money on the occasional extra pack you have to buy out of pocket.
Most doctors understand the need for pediatric incontinence supplies and will work with us to help you get them covered. But a few don’t. Some, for instance, might only prescribe treatment to address the root cause of incontinence, but won’t prescribe supplies. In cases like this, we’ll talk to the doctor to try to change their opinion. But as a last resort, it might be worth exploring other primary care doctors for your child. If you do switch, remember to let us know immediately so we can update Medicaid.
Getting the pediatric incontinence supplies you need doesn’t have to be a pain. But navigating Medicaid coverage by yourself can be a frustrating process — especially if you run into roadblocks.
Luckily, the right partner can help you avoid (or quickly get past) any roadblocks, so all you’ll have to do is answer a few phone calls and see the doctor twice a year.
The rest of the time, you just get your products shipped right to your door. Because trust us: You have enough on your plate as it is. The least we can do is make this process easier for you.