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06-26-2008, 06:27 AM
|  | Senior Member
I am a: Type 2 | | Join Date: Mar 2008 Location: Nova Scotia, Canada
Posts: 1,873
| |  Change of Insurance
A couple of months ago I upgraded to the MM 722 pump but am paying for it myself (interest free credit through MM) as my current employment benefits package only covers the supplies and not the pump. Now I have the chance of a new job (actually it would be going back to an old job but it's a long story) and the health benefits there DO cover the pump. 
Anyone else been in this situation? I will be talking to my MM rep and hope to arrange some kind of deal... I don't want to do anything fraudulent, but perhaps I could get them to see the last couple of months as a loaner or a rental, and then get them to order me a "new" pump with my insurance coverage.
Any ideas or suggestions? 
__________________ ~ Frank Metabolic Syndrome Dx'd March 2003. Started MM 712 Pump April 2004. MM 722 + Contour Link April 2008. "...subjects lose weight by restricting only sugars and starches, without feeling any particular sense of hunger. Moreover, the less carbohydrates in their diets, the greater their weight loss, even though all her subjects were eating equivalent amounts of calories and protein" - Gary Taubes, describing research by Margaret Ohlson |
06-26-2008, 06:32 AM
|  | Senior Member
I am a: Type 1 | | Join Date: Sep 2005 Location: Cincinnati, OH
Posts: 8,291
| | | Wow, that's a good one. I would talk with MM and ask them to try and put the bill through to your new insurance. It will take some work on their part though as they would need to reflect that you got the pump after your insurance started. I would start with them though. Worst you do is order a new pump and send your current one back for a credit towards the deductible on the new one.
__________________
●Blue Ash, Ohio Police Dispatcher
●Type 1 diabetic for 25 years (11 months old)
●Animas pumper since December of 2002
~IR 1000 (Dec. 2002-Jan. 2005)
~IR 1200 (Jan. 2005 - ?)
●LifeScan OneTouch UltraSmart Diabetes is an Art, NOT a Science. You must master the control by skills and not by knowledge alone. |
06-26-2008, 04:52 PM
| | Senior Member | | Join Date: Sep 2004
Posts: 5,595
| | | Unfortunately, they won't cover it. The pump was a service rendered before your insurance was active. |
06-26-2008, 05:34 PM
|  | Senior Member
I am a: Type 1 | | Join Date: Feb 2006 Location: Northern Utah
Posts: 842
| | Quote:
Originally Posted by Funnygrl  Unfortunately, they won't cover it. The pump was a service rendered before your insurance was active. | Funnygrl is right. I work with insurance and have for over 3 years now, and they will not cover it. The Date of Service will be the same. If the rep were to try to change the date of service, or say that your pump is just on loan from the past few months, that would be insurance fraud. Especially if you have made some payments on it already. When minimed does a loaner, they do it for free (but you pay for the sets you use usually), and it is only like a couple weeks that they let you use it I think.
It would be really great if they did cover it, but they just can't do it now that it is purchased and in use for insulin delivery. Sorry to be the bearer of bad news! I know how hard it is to pay for those out of pocket. That is how I got mine. It will be out of warranty before I am done paying for it too!
__________________  Laura Anne  "Happy Day! All is well! Pumping with Paradigm 712 since November 17th, 2004 Type 1 since April, 1995 |
06-26-2008, 05:49 PM
| | Senior Member
I am a: Type 2 | | Join Date: Mar 2008 Location: Nova Scotia, Canada
Posts: 1,873
| | Oh well... I had to look into it anyway. Thanks for the feedback
__________________ ~ Frank Metabolic Syndrome Dx'd March 2003. Started MM 712 Pump April 2004. MM 722 + Contour Link April 2008. "...subjects lose weight by restricting only sugars and starches, without feeling any particular sense of hunger. Moreover, the less carbohydrates in their diets, the greater their weight loss, even though all her subjects were eating equivalent amounts of calories and protein" - Gary Taubes, describing research by Margaret Ohlson |
06-27-2008, 05:07 AM
| | Senior Member
I am a: Type 2 | | Join Date: Mar 2008 Location: Nova Scotia, Canada
Posts: 1,873
| | | I am still waiting for my MM rep to get back to me but, as above, I don't want to do anything fraudulent.
Potential good news is that I just heard that in the insurance coverage it states that, "Diabetes supplies including Insulin Pump and diagnostics are all covered at 100%, no deductible."
I'm hoping that "diagnostics" includes CGMS.
__________________ ~ Frank Metabolic Syndrome Dx'd March 2003. Started MM 712 Pump April 2004. MM 722 + Contour Link April 2008. "...subjects lose weight by restricting only sugars and starches, without feeling any particular sense of hunger. Moreover, the less carbohydrates in their diets, the greater their weight loss, even though all her subjects were eating equivalent amounts of calories and protein" - Gary Taubes, describing research by Margaret Ohlson |
06-27-2008, 01:07 PM
| | Senior Member
I am a: Type 1 | | Join Date: Feb 2006 Location: Northern Utah
Posts: 842
| | Quote:
Originally Posted by fgummett I am still waiting for my MM rep to get back to me but, as above, I don't want to do anything fraudulent.
Potential good news is that I just heard that in the insurance coverage it states that, "Diabetes supplies including Insulin Pump and diagnostics are all covered at 100%, no deductible."
I'm hoping that "diagnostics" includes CGMS. | CGMS isn't diagnostic. They already know that you have diabetes. Diagnostics means anything that they test on you to show you have the particular condition, diabetes. The Diagnosis. But hopefully they have this insurance for you next time you need a pump! It is few and far between that a person's insurance plan will pay it at 100% for both the pump and the supplies!! This is going to save you a lot either way because for the pump you have now, you won't have to pay any out of pocket for your supplies. That is a great plan you have there!
__________________ Laura Anne "Happy Day! All is well! Pumping with Paradigm 712 since November 17th, 2004 Type 1 since April, 1995 |
06-27-2008, 01:57 PM
| | Senior Member
I am a: Type 2 | | Join Date: Mar 2008 Location: Nova Scotia, Canada
Posts: 1,873
| | Thanks. I believe it is a good benefits plan yes! And I do appreciate how lucky I am... believe me!
You may well be right about "diagnostics" but as we don't pay (directly) for blood tests etc... up here I'm not sure what else it could be.
__________________ ~ Frank Metabolic Syndrome Dx'd March 2003. Started MM 712 Pump April 2004. MM 722 + Contour Link April 2008. "...subjects lose weight by restricting only sugars and starches, without feeling any particular sense of hunger. Moreover, the less carbohydrates in their diets, the greater their weight loss, even though all her subjects were eating equivalent amounts of calories and protein" - Gary Taubes, describing research by Margaret Ohlson |
06-27-2008, 03:50 PM
| | Member | | Join Date: Feb 2008 Location: Brooklyn, NY
Posts: 203
| | Quote:
Originally Posted by fgummett Thanks. I believe it is a good benefits plan yes! And I do appreciate how lucky I am... believe me! | But I thought you Canucks had province-wide/national coverage, not employer-based. What's that about? Quote:
Originally Posted by fgummett You may well be right about "diagnostics" but as we don't pay (directly) for blood tests etc... up here I'm not sure what else it could be. | I would think CGMS would generally be covered in "diabetes supplies." The quote says "including"--not "limited to." They're giving examples, not telling all. |
06-27-2008, 04:09 PM
| | Senior Member
I am a: Type 2 | | Join Date: Mar 2008 Location: Nova Scotia, Canada
Posts: 1,873
| | Quote:
Originally Posted by pegasus But I thought you Canucks had province-wide/national coverage, not employer-based. What's that about? | Doctors visits are covered but not prescription medications or devices... although there is a social support for the elderly and those on low/no income. I was in a car wreck over Christmas and got a bill for the ambulance. Emergencies and Hospital stay is covered, as are lab tests, x-rays etc... and required surgeries but there is a long waiting list. Health care is actually managed individually by each Province although they do get money from the feds... and this does lead to disparity in treatment depending on where you live 
__________________ ~ Frank Metabolic Syndrome Dx'd March 2003. Started MM 712 Pump April 2004. MM 722 + Contour Link April 2008. "...subjects lose weight by restricting only sugars and starches, without feeling any particular sense of hunger. Moreover, the less carbohydrates in their diets, the greater their weight loss, even though all her subjects were eating equivalent amounts of calories and protein" - Gary Taubes, describing research by Margaret Ohlson |
06-27-2008, 05:37 PM
| | Member | | Join Date: Feb 2008 Location: Brooklyn, NY
Posts: 203
| | Quote:
Originally Posted by fgummett Doctors visits are covered but not prescription medications or devices... although there is a social support for the elderly and those on low/no income. I was in a car wreck over Christmas and got a bill for the ambulance. Emergencies and Hospital stay is covered, as are lab tests, x-rays etc... and required surgeries but there is a long waiting list. Health care is actually managed individually by each Province although they do get money from the feds... and this does lead to disparity in treatment depending on where you live | Insane. How people working for insurance companies/agencies don't slit their wrists with thin-edged paper I'll never know--having to look over those forms day after day would do it for me! 
Oh, right--they've been replaced by computer screens. 
But I'd still submit for the CGMS if you want it--if "insulin supplies including pumps" are included, it sounds to me like that might be as well. Your supplies *for* the pump are covered, right?  |
06-27-2008, 08:39 PM
| | Senior Member
I am a: Type 1 | | Join Date: Feb 2006 Location: Northern Utah
Posts: 842
| | The CGMS would be covered as a DME supply just like test strips and pump supplies. I am sorry, I didn't see you were in Canada Things are run a bit differently up there But, yeah, if the pump supplies are covered 100%, I imagine that CGMS would be covered the same way. But it would be under a different type of benefit than your labs and such. Or at least it would be here in the US. I know that a lot of insurance companies here are still requiring a prior auth for the CGMS. Not sure how that would work up there either, but since it is still relatively new for normal home use, they require an auth first. But, they are not hard to get. I did a couple of auths for these at my old job and it only takes a few days usually, depending on the insurance company.
Have you heard from your rep yet?
__________________ Laura Anne "Happy Day! All is well! Pumping with Paradigm 712 since November 17th, 2004 Type 1 since April, 1995 |
06-28-2008, 04:31 AM
| | Senior Member
I am a: Type 2 | | Join Date: Mar 2008 Location: Nova Scotia, Canada
Posts: 1,873
| | Thanks! Quote:
Originally Posted by lelggren Have you heard from your rep yet? | Not yet but we have a long holiday weekend so I'll keep you posted when I do hear
__________________ ~ Frank Metabolic Syndrome Dx'd March 2003. Started MM 712 Pump April 2004. MM 722 + Contour Link April 2008. "...subjects lose weight by restricting only sugars and starches, without feeling any particular sense of hunger. Moreover, the less carbohydrates in their diets, the greater their weight loss, even though all her subjects were eating equivalent amounts of calories and protein" - Gary Taubes, describing research by Margaret Ohlson |
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