Caps from insurance on Pumps and supplies

[Angelique]

Have any of you run into issues with caps or topping out amounts on your pump and or supplies? The company my dh use to work for had a cap of $3500.00 a year on durable medical which is what pumps fall under. The current job he has does not have a cap at all. He is looking at a new job with a considerable pay raise for us but they have a $5000.00 lifetime cap. He is turning down the job b/c there is no way I can survive with a 5k cap on supplies and or pump.

Anyone else have this problem?

[JediSkipdogg]

I have never run into that problem. But then again, I have always worked for the government and therefore we have excellent coverage.

[Cyborg]

My insurance company tried to pull the same with me. They would, repeatedly, fail to read the exception clause regarding diabetes related durable medical supplies. Get your "Certificate of Coverage, Riders, Amendments, and Notices" and read it yourself...

[JasonJayhawk]

That's amazing -- was the company he was going to work for small? My endo warned me against working for companies under 5,000 employees, and said a minimum of 1,000 employees would be needed to avoid being seen as a gigantic blip on the radar screen.

[Cyborg]

Not sure what you mean...

I work for a very small company and I have excellent health insurance. It's up to your employer.

[JasonJayhawk]

I mean that small companies are less likely to pay for coverage that is beneficial to people who cost the system $10K/year on average (e.g., type 1 diabetes).

Here's a story of a guy who was "let go" after the employees in his small company figured out he was diabetic:
deleted links to other forums NA

Although, there are plenty of exceptions. The "large" 6000 employee health IT company I was working for cut health benefits to the point of it being a minimum $5K/year pay-cut for me. So maybe I don't have a point after all.... lol :marchmell :marchmell :marchmell

[poodlebone]

That's amazing -- was the company he was going to work for small? My endo warned me against working for companies under 5,000 employees, and said a minimum of 1,000 employees would be needed to avoid being seen as a gigantic blip on the radar screen.

I work for a small company and my pump & supplies were covered 100%. We have an HMP plan and I have never had any problems with it. I get all of the test strips and insulin that I need. We have maybe 20 employees on the health plan.

[Cyborg]

I know the cost of my insurance and it's very high, over 1200$ a month. I do not spend that much on supplies and visits. So the insurance companies still win, IMO...

[Angelique]

They would, repeatedly, fail to read the exception clause regarding diabetes related durable medical supplies. Get your "Certificate of Coverage, Riders, Amendments, and Notices" and read it yourself...
Awww, that is intersting, how do I go about finding this clause? Or, where do I find the "certificate of Coverage, Riders, Amendments and Notices"? From them the insurance company? Since my dh is not an employee it is hard to get information since I can not talk to the insurance directly, they won't give me any information.

The company my dh has been working for both are smallish but not tiny either, about 400+ employees.

[JediSkipdogg]

You would get it most likely from HR as they are usually the ones that handle all insurance info. Depending on how it's laid out, it may be a small book or a few pages. The key part is a table that shows your coverage levels. If I get my printer tomorrow I'll scan what mine looks like. Then alot of new ones these days have diabetic clauses in them as well.

[Cyborg]

Yeah, either HR or the insurance company...

[Angelique]

Update, they must really want my dh to work for them b/c now they have raised his salary to cover the extra costs after the insurance caps out. Wow, never had that happen before so I guess things might turn out okay in the end. I am still a little leary about the cap since I have 2 kids and who knows what the future holds and if their needs may ever require durable medical. Guess we will take it one day at a time.

Thanks for the help.

[Cyborg]

In terms of overall caps, I recently found out that my policy has a 2 million dollar overall cap. Once I use that much insurance, I guess I'm SOL...

[JediSkipdogg]

In terms of overall caps, I recently found out that my policy has a 2 million dollar overall cap. Once I use that much insurance, I guess I'm SOL...

No, you jsut quit your job and go to another job with different insurance. Just the first question you ask when they say "do you have any questions for us now?" you ask..."Yeah, who is your health insurance wiht, because I've maxed out my 2 mill cap on my previous one."

Or when they ask why you are looking for a new job, say the old one refuses to pay medical insurance anymore. Then tell them your entire body is artificial or some cyborg type thing, as getting to 2 million dollars is pretty hard.

[Cyborg]

Unfortunately, the cap applies whether you are a single insured person or whether you are married with 20 kids... :hmmmm:

[jenet]

Unfortunately, the cap applies whether you are a single insured person or whether you are married with 20 kids... :hmmmm:
And are you planning on 20 kids? :eek:

:laugh: cheers,
j

[lelggren]

I hate the whole stupid DME cap thinger. Mine is $2500, and so I can't get another pump for as long as I work here, or as long as my work has this same insurance policy. So, let's hope that mine never breaks once it's out of warranty ;)

[Cyborg]

And are you planning on 20 kids? :eek:

:laugh: cheers,
j


2 is plenty! Not sure I could handle any more...