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[IP] insurance companies & "durable medical supplies"

Jennifer, Ted:

When I first went on the pump, about 18 months ago, I had the same
problem with medical insurers.  I live in Massachusetts and have
Medicare as my primary and Medex Gold (a Blue Cross product) as my
secondary insurance.

Medicare would have nothing to do with pump supplies at all, as
expected.  When I called Medex, I was told that pump supplies were
"durable medical supplies" and not covered by my policy - even though
insulin syringes, which I'd been using for years, were covered.

I submitted a complaint to Medex and, after a period of time, was turned
down.  I then called the Massachusetts Insurance Commission, a state-run
agency, and asked for their help.  They gave me instructions on how to
file a complaint to them, which they would then undertake as advocates,
I was told.  I wrote the letter, emphasizing that it was illogical to
cover syringes but disallow supplies for an insulin pump, which almost
certainly would give me better control.  

Within about three months, Blue Cross reversed themselves, and my pump
supplies are not fully covered under my prescription policy.  A 3-month
supply of setups and reservoirs (you need separate Rx's) costs me

Coverage policies will vary from state to state, and also according to
how much you pay as an insurance premium.  But the squeaky gate still
gets greased!

Best of luck,


"Jennifer G." wrote:
> The issue I'm having trouble with, is that the insurance company is
> me that pump supplies would need to be filed under my medical
insurance as
> "durable equipment" in order to be reimbursed.  That might not be a
> ordinarily, but my lifetime cap for durable equipment is $10,000.
> insurance company uses a mail-order service for
medications/supplies which
> are replenished (insulin, syringes, and test strips are included).
> the mail-order company tells me that insulin pump supplies are not
> under our plan.

Yes, they usually aren't covered as supplies, but as Durable Medical
(or DME). You will almost certainly have to mail order them separatly
and have
the supplier forward bills to your carries, but you need to
pre-arrange the 
connection first, before ordering anything.

> I hate to just roll over and play dead with this--particularly
since I am
> the first pumper that the insurance company has dealt with under my
> employer's policy.  I don't want to be responsible for setting a
> precedent for other pumpers who follow after me.  I'm just not sure
what my
> rights are at this point.  Can anyone out there who has had to deal
> insurance company bureaucracy give me some advice as to how I might
be able
> to get the insurance company to provide me with the mail-order
service for
> my pump supplies? 

It's really too specialized for them to handle, and they will refuse
Unfortunately that's how the rules go, pump supplies are DME....

Ted Quick
email @ redacted
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org