I have always been intrigued about the discussions between prescription coverage and DME. Since I just used UnitedHealthCare, I never had to worry about the distinction.
I ordered some infusion sets from MM a couple of weeks ago. Since I have new insurance, I knew it would take a while. I just found out that BC/BS of Mass doesn't cover my prescriptions, Medco does. Major bummer. But apparently, pump supplies aren't covered as prescription drugs. I called BC/BS to try to figure out what was going on. When I explained to the lady on the phone that I wondered how my infusion sets were covered, she was clueless. I explained "infusion sets for insulin pumps" and she put me on hold for about 10-15 minutes.
She came back and told me they weren't covered as DME, but rather "prosthetic equipment" and I had a $350 deductible with a 10% copay. WTF??!!??
I am seriously pissed. I never had a deductible with UHC back in Colorado, and now I'm going to have to essentially pay OOP for 4 boxes of sets?!? I was told this BC/BS was much better than the UHC policy I had. I don't think so.
Tom
Full Version: Prosthetic equipment?!?
QUOTE(gigem99 @ Jul 17 2009, 05:56 PM) 
I have always been intrigued about the discussions between prescription coverage and DME. Since I just used UnitedHealthCare, I never had to worry about the distinction.
I ordered some infusion sets from MM a couple of weeks ago. Since I have new insurance, I knew it would take a while. I just found out that BC/BS of Mass doesn't cover my prescriptions, Medco does. Major bummer. But apparently, pump supplies aren't covered as prescription drugs. I called BC/BS to try to figure out what was going on. When I explained to the lady on the phone that I wondered how my infusion sets were covered, she was clueless. I explained "infusion sets for insulin pumps" and she put me on hold for about 10-15 minutes.
She came back and told me they weren't covered as DME, but rather "prosthetic equipment" and I had a $350 deductible with a 10% copay. WTF??!!??
I am seriously pissed. I never had a deductible with UHC back in Colorado, and now I'm going to have to essentially pay OOP for 4 boxes of sets?!? I was told this BC/BS was much better than the UHC policy I had. I don't think so.
Tom
I ordered some infusion sets from MM a couple of weeks ago. Since I have new insurance, I knew it would take a while. I just found out that BC/BS of Mass doesn't cover my prescriptions, Medco does. Major bummer. But apparently, pump supplies aren't covered as prescription drugs. I called BC/BS to try to figure out what was going on. When I explained to the lady on the phone that I wondered how my infusion sets were covered, she was clueless. I explained "infusion sets for insulin pumps" and she put me on hold for about 10-15 minutes.
She came back and told me they weren't covered as DME, but rather "prosthetic equipment" and I had a $350 deductible with a 10% copay. WTF??!!??
I am seriously pissed. I never had a deductible with UHC back in Colorado, and now I'm going to have to essentially pay OOP for 4 boxes of sets?!? I was told this BC/BS was much better than the UHC policy I had. I don't think so.
Tom
Every insurance is different. SOme have no deductible, some have a high deductible, some have co-pays/co-insurance and some don't. My biggest fear after not having insurance is having to switch insurance companies!
Did you call Minimed and ask them to find out about it? They have insurance people who seem to know about all of the different plans. I know that the few times I called them and told them what insurance I have they knew right away what was covered and how.
If you don't have the $350 to pay out up front maybe you can order one box at a time until it's paid off, assuming you have some extra sets just in case.
QUOTE(Liz @ Jul 17 2009, 06:07 PM)
Did you call Minimed and ask them to find out about it? They have insurance people who seem to know about all of the different plans. I know that the few times I called them and told them what insurance I have they knew right away what was covered and how.
If you don't have the $350 to pay out up front maybe you can order one box at a time until it's paid off, assuming you have some extra sets just in case.
If you don't have the $350 to pay out up front maybe you can order one box at a time until it's paid off, assuming you have some extra sets just in case.
MM says that they are working on verifying my coverage. I'm sure they are doing all they can to get me the lowest cost - they seem to be very good about that.
I have the money (I'm employed again!), but it just burns my butt. Had to rant.
Tom
MM bills my insurance (Golden Rule, a division of United Healthcare) and designates everything as 'home health care supplies'. For some reason this is covered at 100% of network negotiated price where DME is covered at 80%. Even when I had United Healthcare (before I retired) this was the case. Every time I got a new pump, the insurance would quote 80%, but when MM billed them it would be paid at 100%.
The point is that MM seems to know the best way to deal with each insurance company, so I would wait and see what they come up with. And even doing that, what they tell you before the first claim is made may turn out to be different from what happens when they put in an actual claim.
Linda B.
The point is that MM seems to know the best way to deal with each insurance company, so I would wait and see what they come up with. And even doing that, what they tell you before the first claim is made may turn out to be different from what happens when they put in an actual claim.
Linda B.
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