I have a feeding tube and a medical prescription for real food because my body can’t tolerate the usual enteral formulas. I have been carried by Lincare. A few weeks ago, I was advised by Lincare that they were no longer going to carry the product as it was not profitable. It was suggested that I could use Liquid Hope which is a vegan certified organic product. I ordered a sample and had no problems with it. When I tried to obtain it a host of problems surfaced. First, getting an appointment to get a new prescription. The producer of the product told me it would take 60-90 days to process my insurance because they use volunteers. I am totally dependent on the use of the feeding tube and access to a product I can consume. I could not accept starving for that length of time. I was told, “It’s a first come first serve basis.” I could order the product and pay out of pocket. It would cost me a good $1000/mo. I am on social security and can’t afford that price. I then tried to find a supplier who could bill insurance earlier. I ended up calling around to everyone I could only to discover that I live in a Competitive bid area and the supplier could not send me the product because of my zip code. I called Medicare trying to get help and a staff person there called around to find someone who might have the product only to discover they did not have it or they could not provide because of the zip code. I did find Option 1 who wanted to help but could not because of the Competitive bid. I called Colorado State Infusion who told me they lose $60 on a 24 packet box and can’t afford to carry the product. Insurance reimbursement is so low. In short, the one supplier who was willing to help me couldn’t because of my zip code. Lincare does not want to carry the product nor does any of the others seeking high profit. I realize I along with others are in the minority in terms of product need because of physical/ medical intolerance of the usual formulas. The question is will Liquid Hope and REALFOOD be able to survive as providers and be shut out of supplying to people in need because of a Competitive bid designation by zip code. This is one of the most absurd things I have experienced in the health care arena where people are leaving out the word CARE simply for profit making. I had starved six weeks waiting for surgery. Then after surgery, my food was backing up into my esophagus and I had to be referred to a specialist to determine if I should have another surgery. Another eight weeks for another surgery and eight more weeks for healing. I am tired of starving. Wouldn’t you and anyone else be? I wanted to take Liquid Hope because it has more calories and protein. How can you help deal with this overwhelming problem that patients in need confront?
I understand there is a Medicare guideline governing suppliers. “If the contract supplier does not ordinarily furnish the specific brand or mode of delivery and cannot obtain a revised prescription or locate another contract supplier that will furnish the needed item, the contract supplier must furnish the item as prescribed” (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/DME_Ref_Agt_Factsheet_ICN900927.pdf