[jparris1]

One thing I found out recently was that how your strips, lancets and meters are coded for insurance can effect your financial responsibility. When my Dr. wrote a script for me to take to the pharmacy my copay was $45.00 a month for 100 strips. I discovered however that if I receive my strips as Durable Medical equipment then it is a $50 deductible a year and then 100 percent coverage of costs. My Dr. sent over a new Rx to the DME and I was able to save a lot of money. YMMV of course, but it was really useful for me. Since I have Sleep Apnea and use a CPAP my DME deductible was already way covered.

[JasonJayhawk]

Nice to hear that!

Does your DME give them to you on a monthly basis, or do you get one big allotment for the year?

How often do you get new filters/masks for your CPAP?

[mwalt2]

I also found that out (though I already placed 1 order for strips through the mail order pharmacy). My insurance pays 100% durable medical goods with no deductible (pump supplies and strips) and the University of Michigan has a trial program that makes the insulin (as well as any other diabetes drug) free. Certainly better than the old deductible and 20% I had to pay with my old insurance. It's definitely worth finding out the cheapest ways to get things. It'll be nice not to have to pay anything except $15 co-pays at the endo for awhile .

[melissata]

Originally Posted by mwalt2

I also found that out (though I already placed 1 order for strips through the mail order pharmacy). My insurance pays 100% durable medical goods with no deductible (pump supplies and strips) and the University of Michigan has a trial program that makes the insulin (as well as any other diabetes drug) free. Certainly better than the old deductible and 20% I had to pay with my old insurance. It's definitely worth finding out the cheapest ways to get things. It'll be nice not to have to pay anything except $15 co-pays at the endo for awhile .

I hope that you aren't talking about M Care insurance, because they were just bought out by Blue Cross. We has the option to stay with them for 2007, but a lot of our dedctables were going up. Durable medical used to be covered at 100%, but went to 80% for the coming year. We made the change to Health Alliance Plan to save on premiums and keep the 100% durable medical. Of course the contract depends on your employer, but many people don't know about the buyout. Blue Cross is assuming that you will change to one of their plans, but GM doesn't even offer their HMO, and the coverage is not as good.

[samsmom]

We also have health alliance plan HMO and i will not ever switch that insurance when open enrollment starts. My son is on a pump and our durable medical is 100% with no deductables to meet. He also get 350 strips a month, all healthcore (dme store) had to do was put an override through and it was no problem.....we are very blessed with our insurance, i just recieved my sons supply shipment and the total cost of pump supplies was 1,032 and the strips were 842.00...............our co pay was $0....we do have a 10$ copay for meds, but the endo writes sams rx for 2 vials a month...more than enough, with a few spare bottles in the fridge!!!

shannon

[melissata]

Shannon, Thanks for posting about HAP. I have been so happy with M Care, especially when they paid for 2 pumps within 4 months for my daughter because of the safety of the Dtrons being questioned. I will be ordering from Health Core also, and was told that we would need an overide also. She did tell me that they would send out 6 boxes of sets instead of the 4 we usually get, but that they could only send 9 boxes of strips unless we got an override. We had that with Mcare also, but they would not go over 16 boxes for 3 months even though we said that she was testing 8 to 10 times a day. We will actually be saving $ 80.00 per month on premiums and the durable medical will stay at 100%. My daughter does have Medicaid because of her disability, so insulin should still be almost free for her. We only use the Medicaid for the deductables on her meds and office visits. Do you use their mail order for other meds? We will have to change doctors and pharmacies anyway, so I may try the mail order meds. Have you been able to find good doctors? The choices are less than what we have had in the past, and some are teaching offices with residents that will only be there for 3 years.

[samsmom]

we have had nothing but great dr's....it is a pain in the butt to get a referral but the one extra step (to call the ped) to get a referral isnt a big deal to me. we are able to go to beaumont (did not have a good relationship with dr's there) and st johns, and children's hospital...we LOVE childrens hospital and my son see's dr Moltz..she is wonderful.....we do not do the mail order for insulin becuse i just dont trust insulin through the mail...i jsut go to the pharmacy and pay my 10$ sams dr wrote his rx for 2vials of novolog a month, so we always have extra...a healthcore store is right down the street from us so i pick up his test strips from there. we had a problem at first with the amount but i found one healthcore employee that is EXCEPTIONAL and she put the override in..she actually got me a one yr override so that everytime we come in, she doenst have to do it again...healthcore does 3 month orders so we walk out with 21 boxes of test strips!! health core has us on auto shipment for the pump supplies...we get 7 boxes of insets for 3 months and of course the cartridges for his cozmo pump....i know a lot of people balk at HMO's but it has really worked for us......we also have sam signed up under the medicaid program (childrens special health care services) for a "just in case" back up if something ever happens to our insurance....

i have never had a problem with choice of dr's..there are many to choose from. we are signed up under the "henry ford" plan for hap. we primarly use henry ford facilities, which is fine for all of our needs. if we need to go to a different facility, we just get a referral.....we have 6 mo referral to childrens right now, so when that runs out, we get another one

hope that helps

shannon

[melissata]

Thanks. I'm used to the referrals because we have had an HMO for years. Melissa is now 22, and I could stay with the ped docs but they never get the referrals and I have to scramble the day before each appointment. She sees 3 different specialists, so I'm really getting tired of it. I don't like the idea of insulin in the mail either, but my son does it and has not had a problem. I was thinking of getting our other oral meds through mail order which is either Walgreens or Medco. It doesn't save you a lot of money, so I wonder if it is worth it or not. Are you saying that you pick up test strips and they mail you the pumps supplies? I have always gotten them together and was told that is how it would be with Health Core. I would rather get a 3 month supply of everything sent to me, because I don't think there is one close to me.
You probably had the same ped endo as we did at Beaumont. Couldn't WAIT to get out of there. It wasn't the doctor so much as the CDE's. It was one of the things that really got to me when my daughter was diagnosed at 17. We had gotten away from them and got an adult endo for our son, but had to go back to that office and their nutty ideas of putting kids on 4 different insulins at a time!

[samsmom]

I could get everything, pump supplies and test strips on auto shipment, but because of the quanity of test strips i always go up to helthcore myself (two minute drive) and pick them up...i only deal with one employee of healthcore for the test strips ,no one else knows what they are doing and wants to put an override in and make me wait 2 days for the overquanity...this employee put in many hours getting a one yr over ride so i jsut go directly to her to make sure it is done right....not really that much of an inconvience....the main office has all the pump supplies so i just get them auto shipped..... I also deal directly with healthcore for the strips because we use the freestyle flash but like the multiclix lancet...so they work it out for me....i get good customer service there so i figure that one extra trip every 3 months is worth it. I also was able to bring my son in with me to let them see that they were providing a service for a little guy...sometimes on the phone, employees can forget the fact that the patient is a 5yr old little boy, that really needs an overquanity of strips...so basically we put a face to diabetes..it seems to work.

we left beaumont becuase they had no idea how to deal with a baby....sammy was dx at 15 mo old and it was hard!!! they had never dealt with anyone so young...wanted him to be on nph and regular!!! have you ever tried to get a baby to eat on a schedule...many times he would just fight us because he wasnt hungry adn his insulin was peaking!!OMG IT WAS AWFUL....i could not stand the cde's there...they jsut could not grasp the concept that becuse of my sons age, one unit of insulin would drop his 450 pts..which means we had to run him high or risk a serious low...so we switched to childrens hospital and they put my son directly on lantus and diluted humalog..it was a god send...they also had me try insuflon becuse he was getting so many shots a day. then we moved to the pump...i have nothing but praise for childrens hospital....

shannon

[jparris1]

Originally Posted by JasonJayhawk

Nice to hear that!

Does your DME give them to you on a monthly basis, or do you get one big allotment for the year?

How often do you get new filters/masks for your CPAP?

I get 3 months worth of strips at a time.

I get a new mask every three months.

J-

[melissata]

Beaumont endo was not pro pump when my son was interested. They said that he would have to be admitted to the hospital for a couple of days, and he didn't want that. I really think that if he had gotten a pump then, that he would still be on one. Now he doesn't want one, sigh. I used to have arguments when they made me call that CDE. She was always trying to change the wrong insulin! I always won the arguments, and when my daughter was diagnosed I only faxed in her bg's for the first few days. They never said anything to me about it.