I have BCBS insurance, but they do not pay for my insertions. To get them, I have to cough up $140. If anyone out there has any, please let me know. The product # is MMT-399, Paradigm Quick-Sets, for Paradigm 715 insulin pump. I am trying everything. If there is some other resource you know of, I'd appreciate anything.
I am the mom of a pumper, and before we switch insurances or pumps I called the insurance companies and found out what they paid for and how much so that I know what I am expected to pay.
First of all I would find out if the dollar amount they are quoting you is for 1 month or 3 month supply. Usually the pimp companies send you a 3 month supply at one time.
I would also suggest that you check you policy - most policies pay 50% for DME supplies, but have a smaller co pay for diabetes supplies. The thing is when the insurance companies get the bill from the pump companies they process the claims as DMER at 50 % or what ever percentage is in the policy. If you call them and tell them that is diabetes pump supplies you will usually find out that they are paid at higher rate.
Your human resources department can also help you with this.
I recently had this problem. I had called and found out that my insurance would pay 100% for infusion sets, reservoirs and iv3000, but the IV prep and unisolve was paid at 50%. When the pump company called to confirm they were shipping the supplies they told me I wou7ld be responsible for 50% of everything. I called them and told them they were wrong and they double checked me and I was right. You must reconfirm things. Cask your human resources department what your policy pays for diabetes supplies, and DME (durable medical equipment), and pump supplies. They will be able to get the best answers for you.
have they ever paid? and how do insurance companies expect us to pay for this you would think that they paid for the machine they would at least pay something on the supplies and I'm getting worried b/c I'm a new pumper and I haven't had to get my supplies yet, however it is time and I'm just waiting for them to deny me. I just don't understand how they can get by with it.... Sorry I've vented on this but it makes me mad!!!!
I have argued with my insurance comp for months, but since the suppliers are listed as Durable Medical Suppliers, my policy does not cover it. Even though the insertions are not durable, it is somehow coded as durable since it comes from a durable medical supplier. BCBS finally has directed me to their prescrition department for mail orders. They say that if i can get a prescrition from my MD then it is possible they can get me a discounted price or a copay - but only if it can be mail ordered. They are not sure, yet. Checking my application and prescription info.
This is on-going issue. Trying to find the quick-sets, MMT-399, any way that I can since I'm pretty sure I'll have to pay ful price. $140 is for one month supply. It is going toward my deductible ($1000), but not helping me now. When I meet the full deduct., it will be close to the end of the year and it starts over in Jan. I am very upset and almost at point of going back to needles, which I was taking at least 6 shots everyday and getting worse. I don't know which is better-getting into needles that I can afford and take my chances at other medical issues later, or staying on the pump and getting into the biggest debt hole ever and not being able to financially survive.
There should be more info on these problems before buying pump. If I had known how difficult it would be before buying....
I am willing to accept any suggestions at this point.
ask the insuance compay who they consifder as a participating supplier? first alsways ask for the supervisor. Most mail order companies sendy ou 2 months of supplies at a 2 month copay - so you acrually save money. see it the 140 a month or 3 month supplie. . It might cost more out of pocket at one time, but in the long run you will be saving money becasue you are getting 3 months for the price of 2, same with the test stripos etc.
Found out that mail order in not an option. They will not cover my insertions and cannot find another supplier who can. All I have found to get supplies is Medtronic Minimed and Diabetic Promotions. They cost about the same, and muy insurance will not pay them anything. It goes toward my deductible of $1000, but I will pay out of pocket for 8 months. This means that I only get help for the last 4 months, then once the new years starts, I have to pay again.
There are all kinds of studies being done for those who have to take shots. I have tried to get into them, but am denied because of the pump. It gets more and more frustrating everyday.
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