My name is Tara. I am fairly new to this site. I have read lots of stuff, but never wrote anything myself! Now I have an issue!! My current employer has CIGNA health insurance which is fantastic! They have paid for the majority of my pump stuff and my CGM stuff. I am fixing to change jobs and my new employer has QualChoice health insurance. Until recently I had NO IDEA that some insurance companies didnt cover pump stuff AT ALL!! This is crazy to me! I am scared to death now that my new insurance isnt going to cover my stuff :( I have come to be EXTREMELY dependant on my pump AND my CGM and dont want to give them up!! Does anyone know anything about insurance or have any of you had any problems like this??
Can you talk to the HR director (or whoever buys the insurance) at your new job and get the number for the insurance plan and the group number? I doubt the HR people will know about durable medical equipment coverage, esp the CGM, off the top of their heads. But, you could call the new insurance company and ask. I'd be pretty surprised if pumps weren't covered, but who knows w/ the CGM. Hopefully everything works out so you can take this new job!!
(If the new company says they'll decline coverage, I'd have your pump and/or CGM companies help you w/ an appeal -- b/c they want to receive your money too, they're usually pretty helpful. Maybe you'll get the coverage anyways!)
I agree that calling the new insurance company and outright asking what their coverage is for durable medical equipment, and insulin pumps/CGMs specifically. Most, if not all, plans cover insulin pumps at this point - it's just a matter of how much of it they'll cover. CGMs are a relatively new technology, which explains why not every plan covers them yet.
I've changed insurance companies several times in the last 10 yrs. Even when my employer kept the same company but changed the plan, I've had to fight battles. I hope my hard lessons will help you some:
First question to ask - what is their DME (Durable Medical Equipment) policy - how much of the item(s) do they cover.
related question, what is considered in network vs out of network.
Next, you need to specifically ask one of the health insurance CSRs WHO you can order your pump supplies from
the insurance co may be contracted with a 3rd party distributor and not directly with the pump manufacturer or vice versa
get company (provider) names and phone numbers of those "in network" - do not hang up the phone until you have at least 2 providers
DO NOT, I repeat, DO NOT let them tell you to look at their "provider list". In my experience, the DME list generally is for hospital beds, canes, oxygen, colostomy bags, etc. RARELY do the providers of those items carry infusion pump supplies.
Also, don't let them fool you that your pump supplies are covered by the pharmacy plan - that covers your insulin, lancettes, and strips, not infusion pump supplies
Go to your state's Department of Insurance website (or call) to find out if there is a mandate to cover all diabetic supplies (I live in MD and I've used that a few times)
Your endocrinologist is a good resource - ask her to provide a "letter of need" for you - mine had a form letter ready with a copy of an article from NIH or the like. You may want your endo to send a diagnosis for you - how you performed as a diabetic pre-pump/CGMS and post. Make sure the doc can support your need for CGMS supplies - continuous glucose monitoring is NOT experimental.
Once you have the percentages of what is covered and not, do the math - what you will have to pay out of pocket. That amount is what you want to have deducted from your paycheck to either an FSA or HSA account. I am not an accountant or financial advisor, so I will not give you finanacial advice, but both the FSA (Flexible spending account) and the HSA (Healthcare spending account) can provide you with pre-tax dollars to pay for your supplies. Google either or both, or look them up on the IRS web site.
Prepare yourself for heartbreak. It may not be the health insurance carrier but your current employer who had eliminated coverage. Don't let them piss you off or make you angry, it won't help. But persevere...ask to speak to the medical review board director directly if you get a lot of grief; you may not get to the top, but talking to anyone in the medical field that serves in an administrative capacity is positive. Just keep stressing that an insurer willing to cover your management of your disease now will be less likely to have to cover the more costly procedures later.