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TALKING POINTS & OTHER INFO
Bill to authorize coverage of ostomy supplies by all major health insurance policies in
New York State
Title: Ostomy Supply Bill: An act to amend the insurance law, in relation to authorizing
insurance coverage for equipment and supplies used for the treatment of ostomies.
Senate Bill Number: S5937
Introducer: Senator Dave Valesky, District 53, Syracuse, NY. 333 East Washington St., Room
805, Syracuse, NY 13202. [email protected]. 518 455-2838.
Assembly Bill Number: A8137
Introducer: Assemblyman William B Magnarelli, District 129, Syracuse, NY. 333 East
Washington St., Room 840, Syracuse, NY 13202. [email protected]. 518 4554826.
Other Keyplayers:
Senator James Seward (District 51; Cortland, Oneonta, Richfield). 41 S. Main St., Oneonta,
NY 13820. [email protected]. 518 455-3131. He is the chair of the Senate Insurance
Committee.
Assemblyman Kevin Cahill (District 103; Kingston). Governor Clinton Building G-4, 1
Albany Ave. Kingston, NY 12401. [email protected]. 518 455-4436. He is the
chair of the Assembly Insurance Committee.
Assemblyman Sheldon Silver (District 65; Manhattan). 250 Broadway, Suite 2307, New
York, NY 10007. [email protected]. 518 455-3791. He is the Speaker of the
Assembly.
To contact your local representative:
For the Senate: Go to nysenate.gov , under “Find my senator”
For the Assembly: Go to assembly.state.ny.us , clicking on “Assembly Members.”
WHY IT IS NEEDED
1. Ostomy surgery is necessitated by a number of different conditions including
inflammatory bowel disease, cancer, birth defects and injury. People of all ages can be
affected; babies, children, and adults. The surgery involves the removal of all or part of the
bowel or bladder and the formation of an uncontrolled surgical opening: a colostomy,
ileostomy, or urostomy. Availability and coverage for ostomy supplies is crucial.
2. The cost of supplies are not covered by every policy:

Not all ‘private’ major medical insurance policies cover the cost of the supplies that are
needed after ostomy surgery. United Healthcare policies, for example, often cover the
surgery but do not cover ostomy supplies unless the employer buying the insurance
specifically both requires it and pays more for it.
 Even some New York State-sponsored programs cover the surgery but not the supplies!
This includes Family Health Plus and Child Health Plus that are specifically for families
with low income but who do not quite qualify for Medicaid. Healthy New York, a statesponsored program for small businesses, also does not cover ostomy supplies.
 Health Care Exchanges (AKA “Obamacare”): The requirements for coverage by health
exchanges are written in terms of very general coverage categories (termed Essential
Benefits) such as ‘hospitalization’. We very much hope that ostomy will be covered, but
cannot be sure that will be the case. It appears that such detailed specifics of coverage on
the exchanges will not be known until the New York exchange goes ‘live’ on October 1, and
then it will be necessary to choose a specific plan within one’s specific county of residence
to get exact details of coverage. We have been told that the intention is to cover ostomy
supplies but this will not be known till then at the earliest, and the level of coverage will
almost certainly still be unclear.
 In the light of such uncertainty and the fact that a large proportion of people will still be
insured through their (or a family member’s) employer-sponsored insurance which will
not be subject to the ‘essential benefits’ requirements, we cannot afford to leave it to
individual insurers to decide whether ostomy supplies should be covered.
 Curiously enough, coverage of diabetic supplies is mandated. Why not ostomy supplies?
3. Covering the cost of ostomy supplies ultimately SAVES costs:
 The cost of one outpatient visit to a hospital, especially to the ER, would far exceed the
costs of ostomy supplies for a significant period. Of course any complication requiring
hospitalization would cost the equivalent of years of ostomy supplies. Lengths of stay are
extended when patients have skin breakdown (leading perhaps to infection) or are unable
to be discharged because of a lack of supplies.
 Home care agencies’ length of care time may also be extended with lack of supplies, or
more frequent visits may be required, leading to greater expense.
 Patients may also experience extended stays at rehab facilities if appropriate supplies are
not available.
4. Quality of life and productivity are negatively impacted.
 Patients may experience uncontrolled leakage and severe skin problems, the treatment of
which is likely to cost considerably more than the cost of suitable products. Social nonacceptance, isolation, loss of work, loss of productivity, loss of income, and depression may
ensue. Caregivers may also experience loss of productivity in caring for someone with an
out of control ostomy. Not having the proper supplies can make the difference between a
return to normal life, function, and productivity, and social isolation for both patients and
families.