As you all should already know – last week we did a great new blog on how to get the best bang for your buck when paying for health insurance. And it seems to have sparked quite a discussion. And there has been one question coming to us over and over from viewers and I wanted to take a few minutes to answer it this week.
You asked: why does insurance cover Men’s Liberty but not adult diapers or pads?
It’s a great question – and it’s the topic for this week’s edition of “Understanding Your Insurance” with Men’s Liberty.
Let me start by giving you one little caveat – there are more than 35,000 different insurance plans in the US right now – so there’s no way I can tell you about each one. We’ve got to make some generalizations and then it’s up to you to look at your policy information or call your insurance company and ask one of their policy experts.
But in general, there are three main reasons for the difference in coverage.
#1: Medicare sets the standard and most insurance companies follow their lead. Today, Medicare and Medicaid provide insurance coverage to roughly 1 in 3 Americans. That makes them a market leader – and the standard other plans are measured against. Medicare does not cover absorbent incontinence supplies, therefore most insurance companies follow their lead. Now there are some “cadillac” insurance plans out there that may cover some of these supplies but to be honest, I’ve never seen one.
Which leads us to #2: adult diaper manufacturers don’t want it to happen. Insurance coverage for any item usually requires proof of medical need and brings along medical coding, billing and documentation requirements. That is a lot of cost for the companies who would have no choice but to pass on the expense to consumers. So the cost of a pad goes up – and now you can’t buy it in CVS or Walgreens – you have to go to a doctor for a prescription. Quite simply – if companies can sell lots more of them slightly cheaper – they STILL make more money. So it’s not in the manufacturers interests to get covered by insurance.
#3: It’s simply too expensive. Let’s do a little math – if 30 million people have urinary incontinence in the US (according to the NIH) and each of those people wears 4-6 diapers a day AND each diaper costs roughly $0.44 that is a total annual cost of $28,908,000,000 each year – i.e. nearly $29 BILLION dollars per year. That is a cost that insurance companies and insurance simply cannot afford to absorb without dramatically increasing everyone’s costs.
So with all that information – why cover Men’s Liberty? Because it’s only for men, because as manufacturers we have been through the Medicare coding verification process, because we provide the required documentation and ultimately – because the benefits outweigh the costs for men with urinary incontinence.
And before I leave you this week, I want to recommend a great video blog called Healthcare Triage. It’s run by Dr Aaron Carroll who is great at explaining all these things. He has a great blog that I’ll link in the description called “What is Health Insurance and Why Do You Need It” that’s filled with lots of great information.
Got insurance questions you need answered – email, call or let us know in the comments.