Hey everyone, with it being open enrolment at work we have switched providers and I am trying to figure out if my provider will cover the dexcom transmitters and sensors. The provider of the insurance at our work is Aetna. Does anyone know if this group typically covers these items?
From my understanding, insurance companies work with individual companies and the individual company decides what is covered and what programs are offered. That is why there are so many differences in plans. Company A may choose to cover everything diabetes while Company B chooses to have only minimal coverage. Most likely you would have to contact the HR department, or whichever group within your company handles the insurance at your company, and ask them about diabetes care with your particular plan.
@aauruski I totally agree, it is an extraordinary pain to drill down to the actual coverage for the actual drugs, devices, and medical supplies - but it is the only way.
the company = the company you work for, they pick and choose what gets covered, what copay (or coinsurance).
once a plan is defined, you can contact the insurance company to determine your costs (deductible and copay/coinsurance) for your particular plan details
most likely the transmitters come out of durable medical devices, the sensors would come out of pharmacy coverage plans each with their own deductibles, . good luck.
@aauruski Welcome Aaron to the JDRF TypeOneNation Forum!
As has been pointed out to you, an “Employer Sponsored” medical insurance plan has many variables, and you should check with your company;s risk management team or with HR for specifics. The Plan is owned by the sponsor [usually employer or union, etc.] and, in your case, Aetna if the “front person” and benefit coordinator.
Chances are, unless the plan sponsor directs differently, Aetna will use its standard claims allowances [including formulary] unless the plan sponsor says otherwise.
You will have to check with Aetna for specifics about your at-work policy. If you already have their plan, it should be relatively easy. Just make sure they check both pharmacy and DME options for coverage. Traditional Medicare covers DEXCOM G5 and migrating to G6. A DEXCOM rep told me that Aetna has the only Medicare Advantage plans in the USA that covers the G6 system, and that Humana has Advantage plans that cover G5, migrating to G6. All this is very difficult to confirm if you are not already a policy holder. I spent a half-hour on the phone with a Humana Advantage Plan rep Tuesday, and he could only verify that neither G5 or G6 was covered as a pharmacy benefit. He was either unable or unwilling to determine if there was coverage as DME.