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.