Insurance and Pump

[Funnygrl]

I talked to insurance today. They confirmed my copay for a pump is $10. :D Unfortunately, I wanted a Cozmo. But that one isn't covered. Only Animas or Minimed. Animas seems cool too though. So I will probably end up with that one. I faxed the info over to Deltec for them to try and get approval though. So we shall see. All I need is a script now. :afraid:

[lelggren]

How Exciting!!!! You must have AWESOME insurance if your copay is only $10!! I'm really happy to hear that for you! Most the time, people's copays tend to be anywhere from $500-$1200.

Please keep us posted on whether or not you are able to get the Cozmo! It is a fun pump. I got to play with one a couple of weeks ago, and they are pretty cool little things :) I haven't gotten to play with Animas yet, but I hear that they are pretty neat as well. I have a minimed, and I love it :) Either way, you are going to love how much your life and your control changes for the good after you have that fun little pump :)

[JediSkipdogg]

I would ask your insurance to send you a letter that it's only $10. That to me is very very hard to believe. I think even on the best insurance plans, people still pay out of pocket 10% minimum, which is around $500 for a new pump. I also know that sometimes insurance companies have no idea what you are talking about when you tell them it's a pump, so they look under some other category. I'm just making sure you don't get a bill in 5 months for $1000 and Animas/Minimed refuse to send you pump supplies till the bill is paid.

[Funnygrl]

I have it in writing now. It's in our written insurance policy. I think she knew what I meant because she was very specific about it being Animas and Minimed.

[koblenz]

I would ask your insurance to send you a letter that it's only $10. That to me is very very hard to believe. I think even on the best insurance plans, people still pay out of pocket 10% minimum, which is around $500 for a new pump. I also know that sometimes insurance companies have no idea what you are talking about when you tell them it's a pump, so they look under some other category. I'm just making sure you don't get a bill in 5 months for $1000 and Animas/Minimed refuse to send you pump supplies till the bill is paid.
I am one of those weird ones. Pump and monthly DME supplies covered 100%. And yes, I do realize and appreciate how **** lucky I am!

[middnite03]

I am one of those weird ones. Pump and monthly DME supplies covered 100%. And yes, I do realize and appreciate how **** lucky I am!


I guess I am lucky too, I also have 100% coverage on dme, the pump, all supplies, and testing supplies also...

guess aetna did one thing right..... :)

[Cinnabon]

I am very happy you are gettign your pump. I always get proof of whtever they say, no matter what.

[am1977]

Good luck! I think you will be pleased with the move to the pump :cool:

[JediSkipdogg]

I am one of those weird ones. Pump and monthly DME supplies covered 100%. And yes, I do realize and appreciate how **** lucky I am!

I wonder if I have that too then. I haven't tried to order a new pump on my current insurance yet. But my supplies are paid at 100% (even though my policy says 80%, not sure how that happens.)

[psilocybin]

lol jealous koblenz...will have a full time job soon and i will make sure its with benefits

[psilocybin]

i am 0% covered yeay me!

[jeggeman31]

I waited til the end of the year to buy my pump. That way I had already paid out my $500 max out of pocket for they year and my pump was covered 100% by the insurance company. I was told that Deltec Cozmo was the ONLY pump my insurance company would cover (when I called them) However Animas got the okay and they paid for an Animas IR1250 and I pay 20% for all my pump stuff and strips for the first $500 then zero out of pocket after that.

[jeggeman31]

i am 0% covered yeay me!


I don't understand how people do it. If I was not covered there would be no way I could do it. Hats off to you !

[psilocybin]

thnks.....to tell u the truth i dont even know how i do it lol

[lelggren]

thnks.....to tell u the truth i dont even know how i do it lol
I hear you! I didn't have insurance for almost 2 years/year and a half. I look back on it now, and I am still clueless about how on earth I managed to pay for those things myself, plus still work part time and go to school. Money wasn't abundant. I am blessed :)

[HollyB]

Congrats on getting your pump approved -- that's a big hurdle out of the way! My son just got an Animas and we're really happy with it; also with how helpful the company has been. Our sales rep drove a 4-hour return trip to meet with us, and then did it again to attend our pump training session, and has been great about returning calls or emails.

We REALLY lucked out with our insurance claim. It turns out that "in fact," our company covers supplies only, not pumps. But because somebody there mistakenly told both me and my company's HR rep that pumps were covered, they decided they had to cough up on a "one-time only basis." The cheque came with a letter of apology for having made an error. Yee-haw! At least we have a few years to save up for the next one...

[Funnygrl]

Smith's medical called me back today. I can get their pump with a $10 co-pay. My first fill on sets and catridges is $20, than after that, they are 100% covered.

[lelggren]

Smith's medical called me back today. I can get their pump with a $10 co-pay. My first fill on sets and catridges is $20, than after that, they are 100% covered.
for those who are getting such great coverage on infusion sets and reservoirs, what is your insurance company? and are there any kind of stipulations or restrictions attached to this wonderful coverage?

[koblenz]

Smith's medical called me back today. I can get their pump with a $10 co-pay. My first fill on sets and catridges is $20, than after that, they are 100% covered.
Woooo Hoooooo! Glad to hear it!

Quick, go kidnap an Endo, make him sign the paperwork, and send it off before anyone can change their mind! Go, go, go!

[jeggeman31]

for those who are getting such great coverage on infusion sets and reservoirs, what is your insurance company? and are there any kind of stipulations or restrictions attached to this wonderful coverage?


I have United Health Care. However the city I work for is self insured. Thus United pays the city for us to carry their cards and for them to do our claims. They have a department just for us and our phone number we call is just ours. The city is the one that tells United what is covered and not and by how much. So my insurance is different in the way I can go to my City Insurance department and write a letter requesting this or that be covered and if they see via claims that enough people are needing this service they will change the contract and cover it.

[jeggeman31]

Smith's medical called me back today. I can get their pump with a $10 co-pay. My first fill on sets and catridges is $20, than after that, they are 100% covered.


That is great news. Many years of Happy Pumping to you :shakehand

[psilocybin]

good news....well soon enough hopefully things go well with the endo

[lelggren]

I have United Health Care. However the city I work for is self insured. Thus United pays the city for us to carry their cards and for them to do our claims. They have a department just for us and our phone number we call is just ours. The city is the one that tells United what is covered and not and by how much. So my insurance is different in the way I can go to my City Insurance department and write a letter requesting this or that be covered and if they see via claims that enough people are needing this service they will change the contract and cover it.
I wish mine worked like that.....I'm very glad to see that there are places out there giving coverage where it is needed. I'm glad for you!!

[JediSkipdogg]

I wish mine worked like that.....I'm very glad to see that there are places out there giving coverage where it is needed. I'm glad for you!!

One word....GOVERNMENT....

I've worked 3 years in government work and it's the greatest health insurance you could possibly get. And us employees have you to thank for it. So make sure you get those tax forms in on time.

[lelggren]

One word....GOVERNMENT....

I've worked 3 years in government work and it's the greatest health insurance you could possibly get. And us employees have you to thank for it. So make sure you get those tax forms in on time.
lol They're in already :)

[sugafreedru]

i have blue cross/blus shield i was told 7 months ago after i sumbitted my insurance info to smiths(deltec) that my pump was covered 100%. Friday i recieved a letter stating that it is not covered and i am liable for the entire $6000. F*** you bc/bs! i called today to appeal.

[JediSkipdogg]

i have blue cross/blus shield i was told 7 months ago after i sumbitted my insurance info to smiths(deltec) that my pump was covered 100%. Friday i recieved a letter stating that it is not covered and i am liable for the entire $6000. F*** you bc/bs! i called today to appeal.

The wonderful world of the insurance company. I wish you much luck in getting this straightened out.

[lelggren]

i have blue cross/blus shield i was told 7 months ago after i sumbitted my insurance info to smiths(deltec) that my pump was covered 100%. Friday i recieved a letter stating that it is not covered and i am liable for the entire $6000. F*** you bc/bs! i called today to appeal.
Do you have something signed by you that said that it was covered at 100%? If so, they have to honor that quote. I know that is what most companies do. They have you sign something that says the insurance coverage, who quoted it to you, and what your copay is, if any. Good luck on the appeal! I hope that they get it figured out for you :)

[poodlebone]

i have blue cross/blus shield i was told 7 months ago after i sumbitted my insurance info to smiths(deltec) that my pump was covered 100%. Friday i recieved a letter stating that it is not covered and i am liable for the entire $6000. F*** you bc/bs! i called today to appeal.

I also have a BC/BS plan, but I'm in New York. It's an Empire Direct HMO plan. When the CDE first mentioned a pump last year I told her I had never thought about it much because of the cost. She said she thought my insurance had an $800 co-pay for the pump but she wasn't sure. She sent my info to Minimed and they contacted me less than a week later. The MM rep told me that my insurance covered it 100%. He said it was one of the better plans and they approved the pump instantly. It was shipped the same day I spoke to the rep and it really was covered 100%, according to the EOB I got from Empire BC/BS. Same for supplies.

[gettingby]

I'm currently dealing with insurance. I just want to know atm how a pump is covered and for how much. You would think I'm trying to get government secrects. My insurance company will take their $140/week (soon to go up) from hubby's paycheck but they won't answer a simple question.
:banghead: :mad: :argh:

[sugafreedru]

my endo's office(i actually work for a hospital and my endo is with in the same company) and the smiths medical rep both claimed bc/bs covered it 100%, i did not ask for anything in writing at the time, they told me they would not proceed with the the pump process without approval from my insurance.


Do you have something signed by you that said that it was covered at 100%? If so, they have to honor that quote. I know that is what most companies do. They have you sign something that says the insurance coverage, who quoted it to you, and what your copay is, if any. Good luck on the appeal! I hope that they get it figured out for you :)

[lelggren]

my endo's office(i actually work for a hospital and my endo is with in the same company) and the smiths medical rep both claimed bc/bs covered it 100%, i did not ask for anything in writing at the time, they told me they would not proceed with the the pump process without approval from my insurance.
I'm guessing that there is just some strange oversight that happened. Are your smith's medical rep, and your endo helping you fight this? Maybe giving you a signed letter stating what they were told? It might have some influence. I'm so sorry that you are having to go through this! And, how nice of them to let you know AFTER they send it to you and get you going! Have I mentioned that I HATE insurance companies????

[2sweet4now]

Those of you who are 100% covered, pump and supplies, are you with HMO's? If so who? I'm about to pay 50% for everything w/ Blue Shield Access+ HMO.

[Shotokan]

I have secondary coverage with HealthNet (an HMO) through my wife's job. I have primary coverage with Anthem BC/BS (a PPO). HealthNet covers pump and supplies at 100%, so I'm completely covered even though Anthem BC/BS covers at 80%. If I could switch to the HealthNet HMO for my primary coverage, I would do it in a heartbeat. My wife's plan is through a state university, so it might be more generous than other HealthNet HMO plans.

[poodlebone]

Those of you who are 100% covered, pump and supplies, are you with HMO's? If so who? I'm about to pay 50% for everything w/ Blue Shield Access+ HMO.

I have an HMO plan, Empire BC/BS Direct HMO. We used to have an Oxford PPO plan at work, which I'm told is their premium plan, but it didn't have prescription coverage, you needed referrals to see a specialist, and they gave us the runaround on so many things. I was nervous when I heard "HMO" but it's worked out great. We've had it for 4 years now and everyone who switched likes it more than Oxford. Prescription coverage, no referrals, and I have never been denied anything. We still have the Oxford plan because some people are just afraid to switch for whatever reason. Both plans monthly premiums are about the same, but we get so much more with the BC/BS HMO.

[JediSkipdogg]

I'm under Humana HMO and they only pay 80%...HOWEVER...Animas has been nice enough the past few months that they have just erased the other 20% of the bill so I don't even have to pay it. So essentually I pay 0%.

[sugarfree76]

i have blue cross/blus shield i was told 7 months ago after i sumbitted my insurance info to smiths(deltec) that my pump was covered 100%. Friday i recieved a letter stating that it is not covered and i am liable for the entire $6000. F*** you bc/bs! i called today to appeal.
I have bc/bs. I haven't heard wind of this

[JediSkipdogg]

I have bc/bs. I haven't heard wind of this

Remember, insurance companies have like 2000 plans they offer. Technically, there are an unlimited number of insurance companies out there if you think about how many ways plans can work. For example if your company wanted to say 20% on insurance, they could call up bc/bs and tell them they no longer want prescription drugs covered. BC/BS would then take that off and save your company money, yet, you'd be SOL.

EVERY part of an insurance plan is adjustable. What one has another may not, even with the same company.

[poodlebone]

Remember, insurance companies have like 2000 plans they offer. Technically, there are an unlimited number of insurance companies out there if you think about how many ways plans can work. For example if your company wanted to say 20% on insurance, they could call up bc/bs and tell them they no longer want prescription drugs covered. BC/BS would then take that off and save your company money, yet, you'd be SOL.

EVERY part of an insurance plan is adjustable. What one has another may not, even with the same company.

Yes, but your job couldn't call up any old time and request that change. They can only be made once a year at your annual renewal time. I work for a small company and somehow I ended up with the task of handling the insurance. 5 years ago (more or less) when a lot of us were complaining about our Oxford coverage, I contacted a broker and arranged a meeting. He went through all different companies, as well as different options within each company, and I took information for the ones that seemed best. Now, since ultimately it was my decision which one to choose I naturally looked for one that seemed most diabetic-friendly, but I did also talk to my bosses.

Last year at our renewal time, to save a little money, I upped our doctor visit co-pay from $5 to $20. I told the employees and only a couple of people grumbled about it.

My boss would love to save money but since he's also on the plan (and is nuts, and goes to doctors all the time and gets loads of prescriptions) I know he doesn't want to cut anything out.

Another way we could save is by adding a hospital co-pay. Right now, if any of us is hospitalized it's covered 100%. We could lower the monthly premium by adding a $250 or $500 co-pay but everyone is really against that idea. Most people will never be hospitalized while on the plan but the thought of having to pay $500 at once isn't appealing. I'm still going to look into that when our renewal comes up again in August. I know I wouldn't like getting a $500 bill from the hospital, but if I'm saving $8/week and go for 2 years without needing the hospital, I'm ahead. And my boss would be saving $8/week for each employee, which is a significant amount for a small company. Employees pay 50% of the premium and my boss pays 50%.

[sugafreedru]

You are correct! I found out this week that Smtihs Medical are at fault. They did not try to get approval from bc/bs before they sent me my pump! i had completed training, sign a letter of medical need, submitted regular glucose logs and a1c's and they did not use any of the information, until this week.... 7 months after my pump start. My endo's office blasted the Smiths rep!

I'm guessing that there is just some strange oversight that happened. Are your smith's medical rep, and your endo helping you fight this? Maybe giving you a signed letter stating what they were told? It might have some influence. I'm so sorry that you are having to go through this! And, how nice of them to let you know AFTER they send it to you and get you going! Have I mentioned that I HATE insurance companies????

[JediSkipdogg]

You are correct! I found out this week that Smtihs Medical are at fault. They did not try to get approval from bc/bs before they sent me my pump! i had completed training, sign a letter of medical need, submitted regular glucose logs and a1c's and they did not use any of the information, until this week.... 7 months after my pump start. My endo's office blasted the Smiths rep!

So is it being corrected and your insurance will pay for it? Or did Smith Medical mess up and give you incorrect info about it being covered?

[psilocybin]

i hate insurance...although i did find insurance that will cover $1000 a year in supplies and 80% off all insulin...its a start =]

[Tim_Roy]

I'm currently dealing with insurance. I just want to know atm how a pump is covered and for how much. You would think I'm trying to get government secrects. My insurance company will take their $140/week (soon to go up) from hubby's paycheck but they won't answer a simple question.
:banghead: :mad: :argh:

Better to let your Endo and your pump rep deal with the insurance people.

You shouldn't need to bang your head like your icon's doing. Let your pump rep fight it out with them. He's got experience in doing this sort of thing, and a financial interest in getting you the pump.

[lelggren]

You are correct! I found out this week that Smtihs Medical are at fault. They did not try to get approval from bc/bs before they sent me my pump! i had completed training, sign a letter of medical need, submitted regular glucose logs and a1c's and they did not use any of the information, until this week.... 7 months after my pump start. My endo's office blasted the Smiths rep!
That's really, really sad.....In the pump process, that is one of the first things you do! You get pre-authorization from the Insurance!!! I am not sure how the insurance will go about covering it now, but I am guessing that you just might get a free pump. Since it was Smiths Medical's fault, their really BIG fault, I am guessing that they might have to fit the bill.

I am guessing that the insurance company won't cover it now just because the Date of service has come and gone long ago, and I am not sure that they will consider back-dating a pre-auth when the service is already given.

What a huge mess! But, I hope that they are able to work out some sort of deal with you!