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> I HATE INSURANCE COMPANIES--PLEASE HELP, INSURANCE ISSUES
DOSIGIRL
post Jun 30 2008, 04:37 PM
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Okay so I have Blue Cross Blue Shield insurance and found out that I will be paying close to $2000 for my pump. Then the supplies for the pump which include the cartridges and infusion sets go toward my deductible. So basically I can't afford the pump. My deductibe is $1000 and from my understanding I have to reach that before any of my supplies are covered??? Then on top of that I'm still paying for test strips as well as other diabetic supplies. I'm so confused, is this basically how all insurance companies cover the pump and their supplies?? Any info would be greatly appreciated.
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HMikeyD
post Jun 30 2008, 08:24 PM
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Not all Insurance Companies are the same, but you have more than one type policy per company. This means you and another person can have Blue Cross and Blue Sheild but your coverage will usally be different. Polices are written to help the consumer have coverage, but are put into a class of coverage, depending or your type of coverage and what you pay is how they figure what they or the insurance company will pay. Diabetics are high cost for insurance compines so usally if you do not have top of the line insurance than your coverage will be as little aas possible.
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Liz
post Jul 1 2008, 02:39 AM
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QUOTE(DOSIGIRL @ Jun 30 2008, 12:37 PM) *
Okay so I have Blue Cross Blue Shield insurance and found out that I will be paying close to $2000 for my pump. Then the supplies for the pump which include the cartridges and infusion sets go toward my deductible. So basically I can't afford the pump. My deductibe is $1000 and from my understanding I have to reach that before any of my supplies are covered??? Then on top of that I'm still paying for test strips as well as other diabetic supplies. I'm so confused, is this basically how all insurance companies cover the pump and their supplies?? Any info would be greatly appreciated.


There are so many different plans & options from all of the insurance companies. Some have co-pays or deductibles, some don't. I have a Blue Cross Blue Shield plan and my pump & supplies are covered 100%.

What state are you in? Most (all but 4, I think) states have laws that say insurance companies must cover diabetic supplies. That doesn't mean they automatically have to give you a pump - they can still charge their co-pays and deductibles, but I thought it meant that things like strips had to be covered in some way.

You can check this link to see what it says about your state. If you're not in the USA, this won't apply!


--------------------
--
Liz
Type 1 4/27/87
Minimed Revel 723 + CGMS
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Beowulf
post Jul 1 2008, 05:26 AM
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QUOTE(DOSIGIRL @ Jun 30 2008, 10:37 AM) *
Okay so I have Blue Cross Blue Shield insurance and found out that I will be paying close to $2000 for my pump. Then the supplies for the pump which include the cartridges and infusion sets go toward my deductible. So basically I can't afford the pump. My deductibe is $1000 and from my understanding I have to reach that before any of my supplies are covered??? Then on top of that I'm still paying for test strips as well as other diabetic supplies. I'm so confused, is this basically how all insurance companies cover the pump and their supplies?? Any info would be greatly appreciated.

Your pump should meet your deductible by itself. It costs somewhere around $6k without insurance. I would think that your supplies should be covered at whatever co-insurance setting that you have. Mine is 80/20, so I have to pay 20% of the total. Check with BC/BS, actually call them since the websites can be a little vague, and see what they say. If that doesn't help, call your benefits administrator at your work place. They should be able to shed some light on things as well.

Justin

This post has been edited by Beowulf: Jul 1 2008, 05:27 AM


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Do not yield to misfortunes, but advance more boldly to meet them, as your fortune permits you. ~ Virgil

T1 since 1990 MDI
MM 722 RT since April 1, 2008
MM 723 RT since April 1, 2010 (Lovin the Blue!)
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DOSIGIRL
post Jul 1 2008, 02:34 PM
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Thanks for the info. I do realize that my deductible will be met if i go with the pump, however, I am worried about meeting my $1000 deductible every year after that just to get my supplies. This doesn't include what i spend on test strips and other supplies. I have the 80/20 policy as well, after my deductible is met. I just wanted to get info on how other plans work. The pump people told me my insurance pretty much sucks as far as with the pump and its supplies. Being on injections right now 3-4 a day, my yearly out of pocket costs for strips, syringes, insulin, etc. is around $600. And that is for everthing!! Which I thought wasn't bad at all. I am so ready for the pump but not all the added costs. I'm scared I won't be able to afford everything. Any suggestions I will gladly take them!!! Thanks again guys for your replies.

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kk77
post Oct 2 2009, 04:37 PM
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QUOTE(DOSIGIRL @ Jul 1 2008, 09:34 AM) *
Thanks for the info. I do realize that my deductible will be met if i go with the pump, however, I am worried about meeting my $1000 deductible every year after that just to get my supplies. This doesn't include what i spend on test strips and other supplies. I have the 80/20 policy as well, after my deductible is met. I just wanted to get info on how other plans work. The pump people told me my insurance pretty much sucks as far as with the pump and its supplies. Being on injections right now 3-4 a day, my yearly out of pocket costs for strips, syringes, insulin, etc. is around $600. And that is for everthing!! Which I thought wasn't bad at all. I am so ready for the pump but not all the added costs. I'm scared I won't be able to afford everything. Any suggestions I will gladly take them!!! Thanks again guys for your replies.



I have the same issue that you do. I was with BCBS for two years. I ordered a new pump that cost about $6000. BCBS applied $1000 of that to my deductible(which was $1000/year for diabetes pump supplies) and they covered 80% of the balance. I was still responsible for the 20% and the $1000 deductible. I received a bill from Minimed for the charges, which I could not pay, so I worked out payments with them. Everytime I ordered pump supplies BCBS paid 80% so I was billed for those. Starting in January my deductible will start over and I will have to meet that $1000 again but this time only on pump supplies. I don't even think I spend $1000 (if I were going out of pocket) in a year on pump supplies so it is like I might as well not even have insurance coverege as far as my pump is concerned. The reason the deductible has to be met is because BCBS considers the pump supplies to be DME(durable medical equipment). I don't know why these can't fall under the pharmacy option. I am very frustrated because since I have deen using my pump I have had superior diabetes management. I do not want to have to go back to injections but at this point what are my options.

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Linda B
post Oct 2 2009, 04:49 PM
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QUOTE(kk77 @ Oct 2 2009, 12:37 PM) *
I have the same issue that you do. I was with BCBS for two years. I ordered a new pump that cost about $6000. BCBS applied $1000 of that to my deductible(which was $1000/year for diabetes pump supplies) and they covered 80% of the balance. I was still responsible for the 20% and the $1000 deductible. I received a bill from Minimed for the charges, which I could not pay, so I worked out payments with them. Everytime I ordered pump supplies BCBS paid 80% so I was billed for those. Starting in January my deductible will start over and I will have to meet that $1000 again but this time only on pump supplies. I don't even think I spend $1000 (if I were going out of pocket) in a year on pump supplies so it is like I might as well not even have insurance coverege as far as my pump is concerned. The reason the deductible has to be met is because BCBS considers the pump supplies to be DME(durable medical equipment). I don't know why these can't fall under the pharmacy option. I am very frustrated because since I have deen using my pump I have had superior diabetes management. I do not want to have to go back to injections but at this point what are my options.

IF your pharmacy option is handled by a company like Medco, call them and make sure that they do not cover your supplies. It's possible that they could be covered either way.
Also, MMM now handles pharmacy type orders for strips etc. You could call their insurance dept and ask them to inquire on your behalf. They have ways to get around some of this stuff. But if you did not ask them to try it, they may be automatically going through your medical plan instead of your pharmacy plan.
With mine, they bill the pump supplies as 'home care supplies' or something like that and it gets covered differently than if it were billed as DME.

Linda B.


--------------------
Linda
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Dave_
post Oct 2 2009, 04:57 PM
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QUOTE(DOSIGIRL @ Jun 30 2008, 09:37 AM) *
Okay so I have Blue Cross Blue Shield insurance and found out that I will be paying close to $2000 for my pump. Then the supplies for the pump which include the cartridges and infusion sets go toward my deductible. So basically I can't afford the pump. My deductibe is $1000 and from my understanding I have to reach that before any of my supplies are covered??? Then on top of that I'm still paying for test strips as well as other diabetic supplies. I'm so confused, is this basically how all insurance companies cover the pump and their supplies?? Any info would be greatly appreciated.



Don't blame the insurance company. The problem you are experiencing has EVERYTHING to do with the specific PLAN that the employer chose. I've got Blue Cross too and pumps cost me just $495. It's all about the PLAN. If the employer "cheaps out", then the employees will pay more out of pocket. Blame the employer. You can't have a Cadillac if you pay Chevy prices.

This post has been edited by Dave_: Oct 2 2009, 04:58 PM


--------------------

Diagnosed T1 in 1978
MDI: 1978 -1996
Started pumping in '96 (MM 506)
MM523 (Blue Revel)
- My wife is a fellow pumper (Pink Revel)
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karen
post Oct 2 2009, 09:24 PM
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What Dave said! You should have a copy of your policy and the coverage is outlined in detail there. If you don't have it, get it and find out. Like others have said, just because BCBS covers supplies for one policy holder doesn't mean it covers supplies for all policy holders. It depends on the individual policy. Employers are also looking for ways to reduce their costs of insurance so they select limited policy options. There is no doubt that pump supplies are expensive, as are the strips, the insulin and so on. Check the pharmacy, and dme sections specifically on your policy Dosigirl, and good luck!
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sarahspins
post Oct 3 2009, 02:32 AM
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Our out of pocket cost was $2500 to get my pump.. that's our deductible. We'll be paying out of pocket (though at insurance contracted rates) for supplies each year until we meet it. It's not cheap, that's for sure (IMG:style_emoticons/default/sad.gif)

I'll basically get 3 months of CGM supplies this year (I'm getting my Dexcom 7+ on Monday) and then next year I am paying out of pocket - not really sure how much I'll be using it once we're paying cash for everything.
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Nell-wnc
post Oct 5 2009, 02:49 AM
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Just a thought: Are you on the "basic" BCBS plan? If so, you may want to consider changing to the 'standard' if your company allows that. November is often the time when you can change your plan--at least for many government type insurance plans. If your insurance contracts don't allow this, at least look to see if there is a higher level plan. Though it costs more than the basic, it will be worth it for the added supplies, etc, plus for when you need the next pump in 4 or 5 years.
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Peter B
post Apr 22 2010, 08:19 PM
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KK77- Part of your insurance dilemna is the way MM is set up. They are not a pharmacy and that is why they don't cover under your RX benefits. I believe a lot of insurance carriers cover pumps and supplies as durable medical equip.
Sorry, this doesn't really help you!
Peter
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Charles
post Apr 22 2010, 11:58 PM
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I also have BCBS, but I have their HMO(Blue Choice) and I only have $1000. DME coverage so I had to pay over 4K for my pump(they paid 1K) but they cover my sets and reservors and my insulin ($20 copay)so it's not bad. Medtronics finnaced the pump(it was about $84/mo and I've paid it off). Beening on the pump is worth it if you can afford it,but I agree that Insurance co suck!


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Dx1984,T2,pump MM722 6-11-08
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Liz
post Apr 23 2010, 01:41 AM
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QUOTE(Peter B @ Apr 22 2010, 04:19 PM) *
KK77- Part of your insurance dilemna is the way MM is set up. They are not a pharmacy and that is why they don't cover under your RX benefits. I believe a lot of insurance carriers cover pumps and supplies as durable medical equip.
Sorry, this doesn't really help you!
Peter


After Minimed introduced the UltraLink meter they tried to get me to order my test strips through them every single time I spoke with them on the phone for any reason. I was happy getting them through the mail order pharmacy along with my medications so I always told Minimed no. In January 2009 my insurance put a cap on the number of strips allowed each month. The next time I spoke with Minimed I asked them how they billed the test strips, as pharmacy or DME and they told me it was as a pharmacy/drug benefit. Either that person didn't know what she was talking about or they are able to bill as prescription/drug as well as DME. I now get my strips through Edgepark covered as DME.


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Liz
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ncpumper
post Apr 24 2010, 09:08 PM
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Insurance companies are not created equal. that's for sure! As others have said, employers choose what level of coverages amounts are availiable. I am one of the lucky ones to be a union member. "Brotherhood of Railroad Signalmen" we have United Healthcare. Our Railroad employees coverage pays 100%.

It is very sad for type 1 diabetics who HAVE TO have insulin, pumps, supplies to live a somewhat normal life and to foot most of the bill for this stuff. It is not right!

I am not sure what the current healthcare reform package just signed in Washington has in store for d coverage but surely it will get better.

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