Hello! My name is Viniti, I am 23yo, and I have been a T1D for the last 14 yrs. I recently got an insulin pump and NOW I am experiencing issues with my insurance. I was told when I first spoke with Medtronic that since my deductible was $1500, I would only have to pay that and my supplies would be covered for the rest of the year. I paid $750 dollars upfront and had them ship me everything. Now, I am receiving calls stating that I owe $1900 to Medtronic and that I was misquoted previously. Every time I call my insurance I get a different answer and every time I call Medtronic I get told just to get on a payment plan and it’ll be fine. Medtronic told me my insurance is wrong, and my insurance has told that Medtronic is wrong.
I don’t know what to do. I feel like I’ve been hoodwinked and now I’m concerned about the financial feasibility of my insulin pump. What can I do? I’m a graduate student in an MS program at ASU, and I have a fixed income right now.
Insurance is a nightmare. I would first call you carrier and ask if the claim has been processed. You should receive an EOB ()Explanation of Benefits). This will show how the claim was processed - in network, covered, deductible applied. If it is an in network provider, you should receive a PPPO )preferred provider) discount which Medtronic cannot balance bill you for. Most insurance carriers require a pump to be pre approved for coverage for an insulin pump. You can also request a case manager nurse from your insurance carrier. Most insurance companies have a nurses line and you can start the process of having a case manager assigned that way. The one for my son has provided exceptional care and assistance with the red tape regarding the insurance company. I am sorry you are going through this headache. It is difficult enough dealing daily with diabetes and the insurance adding to that stress is extremely unfortunate.
Viniti, is your insurance through your parents’ employer or ASU? If so, you can call the insurance administrator that pays the bill every month (parent’s employer or ASU). They are your best bet in finding an advocate.
I do not have any experience with plans purchased on the exchanges.
Without knowing your plan structure, it is hard to explain the cost quote. However, typically you have to cover your annual deductible ($1500 or what remains after your usage prior to this claim) PLUS your % co-pay. You stated your annual deducible is $1500 (which is awesomely low!). What is your plan cost split for durable medical equipment (usually 80%/20%, 75%/25%, or 90%/10%).
Second thought…I have been quoted the cost of a new pump that did not include the 30 or 90 days worth of supplies. Those supplies are subject to your annual deducible and co-pay as well. So, your pump could have been charged at $1500, but your supplies are an added cost.
It means a lot that you responded to my comment. I felt very alone and scared. Thank you so much for your response!
I went ahead and got the EOB and they helped explain how my insurance works. I went ahead and got a case manager through my insurance and has been a godsend. She has made it so that I do not have to worry about things going forward.
Thank you so much for your response. It was REALLY helpful!
I get my insurance through my parents. I finally understand, to an extent, how my insurance works. You were correct - the quote I was given was NOT inclusive of supplies, even though the Medtronic representative said it was. I went ahead and called Medtronic to have a full formal review of my case and I won. Instead of paying $1900, I now only owe $750 for my insulin pump. Additionally, because I’m a student I applied for financial assistance for a $1300 grant to cover my expenses for the rest of the year.
I would have never have known about any of this until I read your response. Thank You!
Mastering our convoluted insurance system is a necessity as a T1, to stay healthy with a long term high quality of life. You did it! Congrats for being tenacious and not accepting ‘no.’ Keep up the great work!
Sometimes the actual pump is covered by one part of your insurance(durable medical equipment), while the supplies are covered by your prescription benefit. But not always! So always make sure to check your coverage, once,twice and even 3 times…
I wish I could write that your experience is unique, but Medtronic has pulled this — in my opinion, it’s a scam — on patients for decades, going all the way back to when they first bought Minimed.
Unless you have the assurance in writing from a Medtronic employee, your most effective options include filing an appeal and (depending on your employer’s size) letting your HR benefits organization know about the issue and how it affects your health. If you have something in writing from Medtronic, send it to your insurer and employer.
Your other options include finding and complaining to your local Medtronic sales rep and broadcasting your story on social media. Again it’s my opinion, but it’s a toss-up which has the most resistance to public shaming: Medtronic or insurance companies.