Insurance Problems

[martinad]

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Has any ever had problems with your insurance coverance for pump supplies? I get my insurance from work and as everyone who wears a pump know we need our supplies. They have not been covering some of my supplies. I have a PPO insurance and I don't understand why and I am sick of fighting. Does anyone have any suggestions? Please Help.

Martina D:confused:

[JediSkipdogg]

Are they not covering a complete order or part of that order? There are multiple reasons but it depends on the situation....

1) Your insurance may only cover 80% and you are getting bills for the other 20%.

2) Your insurance may not cover certain supplies. I once was on an insurance that wouldn't cover the batteries, alcohol wipes, etc. They covered the tubing and cartridges ONLY.

3) You may be ordering more than your insurance allows. I know at one point I was on a 2 changes per day system. That means 5 boxes in 3 months. Well, on one insurance I was only authorized 4 boxes, so my doctor had to write a letter to Animas to send to the insurance company to cover that extra box.

4) You may have reached your max insurance coverage. This is very very rare, but some have max limits in certain areas. I know one member on here that has $1500 on max durable medical equipment a year. Well, pump supplies fall under that and $1500 is only about 6 months worth. So the rest is out of pocket.

Those are the top 3 reasons I know they wouldn't cover supplies unless you are ordering from somewhere else and not from the pump makers (some order supplies from 3rd party suppliers.) So can you elaborate a little more on what they aren't paying for?

[Cyborg]

Ok, one more time...

I suggest you get your "Certificate of Coverage, Riders, Amendments, and Notices" for your policy and read it yourself. Good luck.