As a parent of a special needs child, dealing with pediatric incontinence can feel overwhelming — especially when it comes to ordering Medicaid-covered supplies.
You already have enough on your plate. How are you supposed to find time to get coverage lined up? Will orders arrive before you run out every month? And how will they know what kind to send?
Breathe. It’s going to be OK.
We’re not going to say the process is a cool breeze (there is some work to do). But by knowing the myths from the facts — and what we do to help you navigate it — you’ll have a much easier time getting the supplies you need.
Let’s dive in.
This is one of the most common misconceptions we see.
People simply aren’t aware of the resources available to parents. Some buy diapers for their special needs child at the grocery store — and pay high retail prices because they don’t know they can be covered by Medicaid.
But the truth is, children who are older than 3, are on Medicaid, and have a qualifying diagnosis are generally eligible to have their incontinence supplies covered by insurance.
Meeting the requirements might not be as tough as you thought, but it doesn’t mean you’re automatically covered by Medicaid.
Your pediatrician still must approve the need for diapers based on your child’s specific condition. And because incontinence can sometimes be a side effect of emotional traumas and other conditions, some pediatricians might try to address what they believe to be the root cause of the need instead of approving the diapers.
“Whenever I've got a pediatrician who says, ‘Nope, we're not signing off on this,’ I'm going to go to bat for the parent. I'm going to go to bat for the kiddo. I'll call the clinic and talk to the doctor. It doesn't mean that it's necessarily going to change the doctor’s opinion. But I’m still going to try.”
— Drew Smith, Pediatric Support Specialist, TMS
Some parents believe that only name-brand products (like the big brands you see in the supermarket) have the absorbency they need. But often, off-brand products can be just as effective. So, if your insurance won’t cover a name brand, it doesn’t mean you’re getting a lower-quality product. Parents like us know: What matters most in a diaper is that it’s comfortable and it works.
Fortunately, it’s not a process you have to go through by yourself.
Here are some of the more common bumps you’ll face along the way, as well as how the TMS team works with families to resolve them. (If you’re not part of the TMS family, you can use this as a snapshot of the kind of support to ask your care team about.)
Choosing the right product from multiple options can be overwhelming, but there’s no need to guess and hope for the best.
When selecting products, your rep should listen to your needs, answer all your questions, and recommend a product that will work for your situation. And if you’re still not sure what to select, they should send you some samples so you can try a few options and see what works best.
When your child depends on incontinence supplies, the last thing you want is to reach for a diaper and realize you’re out of them. At TMS, we set up a support network to make sure that never happens to you. It includes:
"If someone calls me and says, 'Hey, I'm short for the month,' that means I'm either going to our supplier and saying, 'Can you ship me more stock? I need to get this out to a patient,' or I'm hopping in my vehicle with the products and I'm going to drive them to the daycare and leave them there for the parent when they pick up the kiddo. Or it means I'm going to the FedEx store and we're going to ship it to them, and it gets there the next day."
— Drew Smith, Pediatric Support Specialist, TMS
You don’t have the time to constantly keep up with Medicaid requirements and news. But suppliers should. So, if you have questions about what’s covered, or if you’re paying for another product out of pocket (like pediatric thickeners or nutrition drinks) and wondering if it could be covered as well, ask us! We’ll find you the answers you need so you can focus on caring for your child.
At TMS, we call you every month to make sure your supplies arrive on time. Make sure you save your TMS representative’s contact numbers in your phone, so you don’t accidentally ignore or decline a call about your shipment.
Your TMS representative will usually direct you to an online form for ordering supplies. Using it can help automate the process and cut down on the time it takes to start the ordering process and receive your supplies.
Don’t be afraid to ask questions. If we don’t know the answer offhand, we’ll find it for you. Our job is to make your life easier and get your child the supplies they need.
While we do everything we can behind the scenes to make the ordering process simple, there are still some tasks you’ll be responsible for, like taking your child to regular well-child check-ups. Staying compliant with these requirements helps to avoid delays in approval, so you don’t run out of supplies. (But don’t worry, we’ll go over these requirements with you, so you’re never surprised.)
Ask for support, and not just when it comes to ordering supplies.
You know the saying, “You can’t pour from an empty cup”? It means to care for someone else, you have to care for yourself, too. So don’t be afraid to ask for some extra assistance, whether it’s finding a support group where you can talk to parents of special needs children or finding a trusted relative who can watch your child for the afternoon while you take a break. Just because you’re someone else’s support system doesn’t mean you’re not deserving of support yourself.
Not sure where to start? We recommend the Children’s Special Healthcare Services office in your county. And social media networks like Facebook groups are another great place to find parents in the same situation. Not finding what you need? Ask us to recommend resources near you.
"Don't be afraid to get on social media like Facebook and find your local children’s special services or other support networks. There are a lot of nonprofits out there that are always trying to raise awareness. Don’t be scared to raise your hand and ask for help or reach out to somebody."
— Drew Smith, Pediatric Support Specialist, TMS
Caring for a child with special needs can be tough.
But we can take one big thing off your plate.
When you don’t have to worry about running out of supplies, you can focus on all the other things on your to-do list. At TMS, we try to make that easier by going the extra mile to get your incontinence supplies to your door, so you don’t even have to think about them. Because we know you’ve got plenty on your mind already.