Insurance companies make no sense

Joeprep4820 · #1 (**permalink**) 10-29-2009, 07:52 PM

I currently am a Deltec Cozmo user and have been for the past two years or so. I recently tried to find a new supplier for supplies since Smith's medical no longer sells the pump, and started by calling my friendly BCBS insurer to find out what suppliers on Smith's list would be covered. I discovered that none would be covered under my insurance, so I said that in that case I would need a new pump, which includes supplies and the $6000 medical device, and insurance was okay with that. Now why are they so willing to pay for a brand new pump (they cover 100%) including supplies for the years I will have that pump, but not pay for supplies from any of the companies listed on Smith's website? I'm not complaining, just very curious.

poodlebone · #2 (**permalink**) 10-29-2009, 08:03 PM

I wish I knew! However, you should ask your insurance what suppliers are in-network and call them. They may still be able to provide Cozmo supplies even if they're not on Smith's list. I use a Minimed pump and get my supplies directly from Minimed because they're in-network with my insurance. Edgepark is also in-network and I could get my stuff from them if I chose but I find it easier to go directly through MM.

Minimed somehow got my insurance to cover a brand new pump when I added the CGMS kit last year even though my original pump was only 3 years old.

sarahspins · #3 (**permalink**) 10-29-2009, 08:31 PM

Animas carries smith's supplies.. maybe you could contact them?

Joeprep4820 · #4 (**permalink**) 10-29-2009, 08:35 PM

I'm just getting the new pump. I named all of the suppliers and none were in network which is surprising. Oh well, another new toy for me

Scratch · #5 (**permalink**) 10-30-2009, 08:17 AM

Quote:

Originally Posted by Joeprep4820

I currently am a Deltec Cozmo user and have been for the past two years or so. I recently tried to find a new supplier for supplies since Smith's medical no longer sells the pump, and started by calling my friendly BCBS insurer to find out what suppliers on Smith's list would be covered. I discovered that none would be covered under my insurance, so I said that in that case I would need a new pump, which includes supplies and the $6000 medical device, and insurance was okay with that. Now why are they so willing to pay for a brand new pump (they cover 100%) including supplies for the years I will have that pump, but not pay for supplies from any of the companies listed on Smith's website? I'm not complaining, just very curious.

The insurance companies negotiate deals with the pharmaceuticals and medical equipment suppliers. Your insurance company won't actually be paying $6000 price tag you see listed, they have a negotiated price that is lower than that.

The present structure of insurance here in the United States has resulted in the sometimes crazy and bizarre pricing that what we as individuals see shown to us and what we don't see in the transactions between the insurance carries and medical suppliers. It's one of the reasons also that makes being uninsured in the United States so damaging at the retail level.

poodlebone · #6 (**permalink**) 10-30-2009, 09:30 AM

Quote:

Originally Posted by Joeprep4820

I'm just getting the new pump. I named all of the suppliers and none were in network which is surprising. Oh well, another new toy for me

Which pump are you going to switch over to? If you go with Animas you can use the same sets you've been using with your Cozmo.

Joeprep4820 · #7 (**permalink**) 10-30-2009, 11:03 AM

Quote:

Originally Posted by poodlebone

Which pump are you going to switch over to? If you go with Animas you can use the same sets you've been using with your Cozmo.

I'm thinking Medtronic, simply for the larger reservoir. I won't always use 300 units in 3 days, but I like having the option to do so.

poodlebone · #8 (**permalink**) 10-30-2009, 11:25 AM

Quote:

Originally Posted by Joeprep4820

I'm thinking Medtronic, simply for the larger reservoir. I won't always use 300 units in 3 days, but I like having the option to do so.

I don't ever use 300 units in 3 days but I like the bigger reservoir on my MM722. I hate filling & changing reservoirs so I fill one completely and use it until it's empty, while still changing the cannula every 3 days. I think I went through a reservoir in 4 days when I was sick earlier this year.

Joeprep4820 · #9 (**permalink**) 10-30-2009, 11:46 AM

Not a bad idea at all. Might have to start doing that.

Real4 · #10 (**permalink**) 10-30-2009, 11:48 AM

Quote:

Originally Posted by Joeprep4820

Now why are they so willing to pay for a brand new pump (they cover 100%) including supplies for the years I will have that pump, but not pay for supplies from any of the companies listed on Smith's website? I'm not complaining, just very curious.

Insurance companies are among those companies which believes that everyone is an idiot including their own employees. Therefore they make rules that FORCE their employees to behave like idiots by removing all discretion and need for thought.

The employees, unfortunately are stupid enough to put up with it, rather than revolting.

foxl · #11 (**permalink**) 10-30-2009, 11:50 AM

Quote:

Originally Posted by Real4

Insurance companies are among those companies which believes that everyone is an idiot including their own employees. Therefore they make rules that FORCE their employees to behave like idiots by removing all discretion and need for thought.

The employees, unfortunately are stupid enough to put up with it, rather than revolting.

AMEN.

but is it that they are stupid enough or paid well enough ... nevermind. They are stupid enough to work for the pay, and that is enough!