Help insurance!

Technology & Management
1

I know this is a discussed topic, but I have BCBS and I had found a compnay called SurePoint Medical (out of Kanas) and they were providing my CGMS and infusion stuff and NOT charging the 20% co-pay.

Well that JUST changed - they can noy service me anymore.

Do you have a company that is in BCBS network (or not) that will forgive the 20% deductable? Or is resonable?

THANKS!!!

Scott

2

I’ve never paid a co-pay for pump/cgm supplies. I have a copay for test strips, lancets, and insulin though. Last year my company went with a plan that included a $250 annual deductible, which of course I was able to meet with my first order of pump supplies once that plan went into effect.

I believe the insurance files my pump supplies under durable medical equipment instead of it being a regular prescription.

3

Scott,

I have BCBS and use a company called Edgepark Medical Supplies that does my CGM supplies. Check it out…

4

Thanks – one company I just called and they wanted $200 a box for the Enlite sensors! I have a $250 dectutable and MAx $2,5000.

Seriouly the Enmite sensors are going to be the cost of a new car!

And Gainesville still does not have a page!

5

Back when I had an individual plan with BCBS, they had a special program that would waive the deductible for diabetes supplies when purchased from Edgepark, but I still had to pay the 20% co-insurance. I think it was called something like health management or diabetes management program. The BCBS plan I have now with my employer does not have the program. You can call BCBS customer service and ask about it. Edgepark is the only company that my insurance plan uses for pump and cgm supplies so that narrows down the options for me!

6

Thanks.

7

Help with Medicare denial of pumps supplies.
Just started Medicare this year - have used a pump almost 20 years but since Medicare did not pay for this pump, they will not provide with me DME( durable medical equipment).

Sent a copy of my bill from Medtronic from 2009 but the appeal was denied.

Any suggestions. I did get a letter of Medical Necessity anf did speak with Medtronic

Any ideas would be great.
Type I for 48 years.

Ros

8

I know Medicare does not pay for any sensor supplies but I have heard of people getting pump supplies.

Since your pump is out of warranty maybe you should ask your doctor for a new prescription for a new pump and then see if Medicare will cover the pump supplies since they’re paying for it?

9

Yes - I will order a new pump next - now that I noticed my current pump has a new crack.

Bureaucracy - and cost. I will get Medicare to pay for a new pump instead of just giving me supplies.

Thanks

Ros

10

Hi -
I am just entering this conversation. Have been Type 1 since 2/09 and received my pump that year through private insurance through employer (Aetna - paid 100%). However, I am not on Medicare and having difficulty getting Medtronic pump supplies, like you, Ros. I know that Medicare does not pay for CGM supplies - bought that on my own recently, but they do pay for pumps and pump supplies. I am going to ask my endocrinologist to order a new one - getting Animas because it just released a version that is integrated with Dexcom CGM. I am tired of caring two devices. Will update you on what I learn.
Thanks
Cyndy

11

Good news - After submitting a Letter of Medical Necessity - I finally got my pump supplies reimbursed. I also contacted my Congrssman and wrote a letter to the Secretary of Health and Human Services.
Amazingly - I received a phone call from a Medicare Insurance specialist assuring me that my Medicare reconsideration had been approved.
Disturbingly, Liberty, a Medicare approved provider ( my pump supplier) should have processed my first order with a letter of Medical Necessity from my endocrinologist.
I am now in the process of updating my Medtronic pump ( out of warranty and has a crack), but Medtronic seems to be quite experienced. Had to send in 30 days of blood test results. Hopefully, I will get new REVEL SOON.

Ros

12

Thanks for the update, Ros. And yes, that is great news! However, you should NOT have had to go so far in your quest for pump supplies! I just re read my earlier post and saw a typo - I AM on Medicare and running into similar issues. I called a company last week CCS Medical and they have not been helpful - keep losing my information and need to verify BCBS secondary coverage.

Anyway, I am going to shoot for the Animas that is integrated with the Dexcom so I don’t have to carry two devices any longer.
Thanks
Cyndy

13

CCS Medical is the worst. I dropped them because their customer service is not at helpful.

14

Thanks for that info, JaniB145. Where do you access pump supplies? From your information, you are probably not on Medicare just yet. I am hoping to have private insurance again one of these days. I’m a student right now - Family Nurse Practitioner course and plan to go to work full time again within the next 2 years.