Re:[IP] Comparing insurance notes
>>My Blue Cross Blue Shield PPO plan considers a pump
>>durable medical equipment, so their $2,000. DME
>>ceiling applies to it. Is this pretty typical? I've
I've had sleep apnea for a long time, and have had a different insurance
company or plan about every 3 years of my life, so I've dealt with
insurance and durable medical equipment for a long time.
What plan you get depends on a couple of factors: how big is the group is
the biggest factor. The other factor is how much does the company want to
spend on insurance. Thus they will go to the table and bargain (I'm not
exactly sure they always are, but it can involve multiple companies).
So what your plan has and does depends entirely on the size of the group
and the negotiating power they have.
For example, I teach school for the second largest school district in the
state of Texas (Dallas). A couple of years ago, we paired with the first
largest school district in the state, and a "company" was formed to
administrate the plans. They were responsible for negotiating what we
got. Which by the way, is a durable equipment budget of $3500. They pay
100% until we hit $3500. Then we (the patients) pay the remainder. We
get a lot of good things for free. We have a 1-800- number with free
CDE's to talk us through problems. I haven't had to pay anything for CDE's
so far, now that I think of it. CDE=Certified Diabetes Educator. I also
haven't had to pay anything for two carpel tunnel surgery's.
On the other hand, the state of Texas put all of the school districts
together that wanted to join, and got the retirement system to
administrater it. I don't know all the details on it, because I haven't
worked with it, but I do know how the durable equipment works. In their
case, durable equipment is 90%/10%, no limit.
Rules change from time to time too. We used to only get three office
visits with each referral to a specialist. Now we get unlimited office
visits for a year.
So the moral of the story is -- every plan is a bit different and just
because my plan is Cigna's, doesn't mean that someone else with Cigna will
get the same benefits.
Marcie (beagle) Bettner's Byte O Magic, NA, NAJ, NAP, NJP, CGC
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