[Previous Months][Date Index][Thread Index][Join - Register][Login]
  [Message Prev][Message Next][Thread Prev][Thread Next]

[IP] Re: insurance quandry

Trish Suchy <email @ redacted wrote:
I just found out that we have a plan that will not let MiniMed (from whom I
have purchased my pump supplies for over 3 years) file my insurance claims
thru their local Blue Cross.  I gather this is a cheaper deal for my
insurance folks, although I am, of course, paying more for the insurance
than I was before it changed.  I had no choice but to change, BTW.  Mind you
it took talking to a zillion people at MiniMed & BC to get that info.  Ergo
my insurance is now treating MM as if it is not part of their PPO, and will
only pick up 30% of the tab for supplies after deductible.  I can't afford
this without considerable sacrifice.  I'm a teacher, and they don't pay us
too well down here.

When asked *where* I can purchase pump supplies "in-network" for my plan,
the insurance office can only give me a list of "durable medical supply"
places.  I began calling those, & many of them are out of business or have
never heard of the pump & never carried supplies like that.  Just standard
stuff like bedpans & walkers.  It was a useless list.

Trish - I switched to HMO Illinois, a BC/BS affiliate 2 years ago.  The first 
time I called Minimed and they got approval from my insurance and everything 
was fine.  The second time, the policy had changed and I had to go through a 
durable supply company (Ultracare) and somehow I ended up with supplies from 
both!  It was a mess and HMO Illinois told me to send one box back. From then 
on I had to use Ultracare because it was the company that my medical group had 
an agreement with.  Can you ask your doctors office how they handle medical 
supplies for your insurance?  I would think they should know who to go 
through.  I really preffered going through Minimed because they knew what I 
was talking about.  Ultracare didn't know anything about pumps (the person 
taking my order asked me if I was an insulin dependent diabetic!) and they 
sent me the wrong infusion sets (later they sent them to me again in addition 
to the corrrect ones and tried to bill HMO Ill for it but I returned them and 
let HMO Ill know what happened).  They also charged twice what MInimed charged 
and I also let HMO Ill know that but they said that it was more convenient for 
them to do it this way and they might save on some other supplies.

Anyway, my understanding was that the medical group is suppose to control 
referrals.  If one of those durable medical supply companies are in-network 
then maybe they will have to order insulin pump supplies for you whether they 
currently do or not.  I have found that I need to give them the specific 
Minmed number and then check when you get it to make sure it is correct.  With 
my plan (in Illinois) all my pump supplies were covered at 100%.  They also 
covered testing strips, lancets, syringes, disposable insulin pens, and 
glycagon at 100%.  With mine and my daughters supplies I am only paying for 
insulin in vials! I am switching back to United Health Care for various 
reasons but mostly because HMO Illinois won't pay for ongoing care when you 
are out of the area and my daughter needs an endo near her at school.  I don't 
look forward to switching and I'm trying to find out what pumps are 
considered "in-network" (used to be Minimed) so I know what my daughter can 
get if she decides to get a pump.  It's too bad that it is so hard to find 

Type 1 - 29 years, pumping 3+
and daughter Melinda, 18 Type 1 - 3 weeks.
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml