Insurance, the Pump, and MDI

CarlyesHope · #1 (**permalink**) 07-15-2005, 12:25 PM

Sorry, I didn't know exactly where to post this...

I have a question and you pumpers can answer this..

Carlye's doc said that if we order the pump our insurance will no longer pay for MDI stuff. (doc is new) We wanted to get the pump now and wait a little while - until Carlye was really ready to be on it. The reasons for getting it now was becasue there was a possibility that her fathers insurance company was going to stop covering the pump and it's supplies come January so we thought that if we got it now it could sit in a box until Carlye was sure.

Did any of you have trouble with insurance once you ordered the pump? I know all insurances are different, I'm just looking for generalization stuff.

Thanks,
Kelly

duck · #2 (**permalink**) 07-15-2005, 12:57 PM

If the doctor prescribes the med, how are they not going to cover it?

Call your insurance company and ask. Let them know what the doc said and then ask them what would happen if your daughter decided she hated the pump/or the medical team decided MDI was better...

As it is, on MDI the only real difference is the using syringes....At 4-6 shots a day, you're talking about having to buy 2 boxes a month of 100 syringes at most (unless I am currently low and my brain can't do the math correctly)...Last time I checked 100 syringes were about $20-$25 dollars.

CarlyesHope · #3 (**permalink**) 07-15-2005, 01:24 PM

On the pump Carlye would also not get Lantus, Pen needles, novalog pens (though she would get it in vials), different testing strips, and, as it is, our medical expenses are thru the roof, I don't know if I could handle $20.00 bucks more..

Cinnabon · #4 (**permalink**) 07-15-2005, 01:26 PM

Yes you want to call your insurance and ask all kinds of questions, don't go by what they told you. I kept as many bottles of the MDI regimen before the pump, just in case. All the "what ifs" must be brought up front. Please ask about the education Carlyle will receive and make sure they cover that, too. You don't want her facing anything like what I went through. Good luck!

Dewey · #5 (**permalink**) 07-15-2005, 01:33 PM

Quote:

Originally Posted by CarlyesHope

Sorry, I didn't know exactly where to post this...

I have a question and you pumpers can answer this..

Carlye's doc said that if we order the pump our insurance will no longer pay for MDI stuff.

Did any of you have trouble with insurance once you ordered the pump? I know all insurances are different, I'm just looking for generalization stuff.

Thanks,
Kelly

Hi Kelly,

I'm not too sure how your insurance works, as each plan's coverage is different, but I didn't experience any issues when making "the switch."

Basically, what happened was, the previous insurance (and the new one) had covered enough supplies to last me even after I began pump therapy. Hopefully, they'll continue to cover Carlye's MDI supplies in the meantime. But, if not, it's like Duck said...

camjen1 · #6 (**permalink**) 07-15-2005, 06:34 PM

I am going to put this as best as I can without sounding harsh but getting a pump way before she is going to be actually using it is like giving here a Christmas gift in July and telling her she can't open it until December. I would say wait up until she is ready and from what it looks like she has great control just on MDI's anyways. Why don't you think she is ready? She has better control than I ever had and I think that alone proves that she is ready.

Has your insurance company approved for a pump yet? You don't want to get all hyped and assume you will get one and then get shot down.

When I first applied for my pump I felt as if I had to prove I was sick enough to get a pump. I think if I would have stated my A1c was in the 5.0 range they would have flat out denied me. I think that is the whole reason you and the DR had a debate about whether or not to put her on the pump. I never had good control and was constantly sick on MDI's. I have never had a A1c below 6 and prior to the pump my A1c was over 15.

I wish you guys luck. What company are you aiming towards?

YouthIncJr · #7 (**permalink**) 07-16-2005, 10:00 AM

Not covering MDI supplies does not make sense. What are you susposed to do if the pump has problems and needs to be serviced? I agree with Camjen1 "it is like buying a Christmas present in July and making her wait until December to open it". Another reason to wait to buy a pump, is technology will change. The real question may be how long until she is ready. If it is a month or 2 then get it now, If it is a year to 2 then wait. The pump could be sitting in a box and the warrenty would be half gone and the pump would not have even been used.

Check with the Insurance Co on the supply issue. There is most likly no way the Doc knows the details of every insurance co. or plan. My insurance sends me both supplies as long as I have the Rx.