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Re: [IP] Medco/test strips FYI

At 01:12 PM 2/28/2009, Jath wrote:
>My strips CANNOT come under the DME part of my policy, as I checked
>that out right away.  But I do get a lot of them from Medco.  I am in a
>COBRA plan with Aetna, but it is a self-funded plan.  Self-funded plans
>can cause a lot more problems, but it is my only choice to have health
>insurance right now.

I have just recently heard of my plan being called "self-funded".  I 
have an individual policy through BCBS of Michigan and since I pay 
the premium totally myself, I guess it is "self-funded".  Luckily, it 
still falls under the Michigan law that requires insurance to pay for 
diabetes supplies.  I have no prescription coverage at all, but I do 
get a discount on generic drugs.  My insulin is covered with a $1,000 
deductible, 30% co-pay the same as my other diabetes supplies.  I 
have to purchase my insulin myself from the drug store and then send 
the receipt to BC to be reimbursed.  Currently my insulin is costing 
me $57 a month for two vials (my 30% co-pay, my deductible has been 
met).  I have no option to get a 90 day supply.  My testing supplies 
are a whole other story since I was incorrectly told by the BC 
customer service representatives that I also had to purchase those 
myself and submit the receipt.  I recently found out that this is not 
correct.  The supplier, if In-Network will bill BC directly.  I will 
only be responsible for paying my 30% co-pay of BC's approved amount 
after deductible.

There is no DME coverage on my policy, but because of Michigan's law 
regarding diabetes supplies, my supplies are treated like DME but covered.

My insurance does have limits on the number of test strips per month, 
200 for Type 1 diabetes, 100 for Type 2, but I disputed this years 
ago and have been getting 300 strips per month.

I was not eligible for COBRA both when my husband lost his job (the 
company went out of business) and when I lost my job (the company was 
too small to be eligible for COBRA) so the individual policy is the 
only option I have at this time.

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