Insurance Bite For Pump Supplies

Back in February of this year I put in the papers with my employer’s insurance to get approval for my insulin pump. It was only a few weeks before my job changed that it came through. At first I hesitated, wondering if it was “right” to get a pump from my old plan, until someone whit some wisdom (my wife) said, “That’s silly- you paid into that plan for years/”

That was good advice, since it was 100% covered under my old insurance and I am sure it is not covered under my new insurance (I went from a large organization of more than 10,000 employees to one that has 6!). Then, I got one of those statements from my old insurance company that I usually glance and discard, a “THIS IS NOT A BILL” statement of coverage– and noticed they paid the full cost of my meter- $5000!.

Woah.

So I got my meter, my first box of supplies, and was off to happy pump land, and saw drastic improvements in my overall blood sugar levels, like a 30 mg/dL drop in my averages.

And in June, it was close to the time to order some new supplies and I wanted to verify my coverage. I checked Humana’s web site (which is a great online tool, much better than I ever had with Blue Cross), and found my Medtronic insulin reservoir listed as a tier 1 co-pay, but could not find the infusion set. So I called Humana, and they said, I had to ask the supplier to put in a request. So I called Metronic, and explained I was trying to find out if these items are covered. They said the only way was to put in an order (which sounded odd, but that was the game).

A few days later, I got a message from Medtronic that said the coverage was confirmed. Cool, I thought, my supplies are going to be easy to order. And it was, my box came.

Then I got the bad news. My claim did not show these items as a $10, $30, or even $50 co-pay, but a total charge to me for this supply of $443! That must be a mistake.

But its not. Under my plan, Humana does not consider these bits of plastic and tubing as a perscription (and what is the difference between the insulina reservoir and a syringe??), but what they term a durable medical supply…. which means I have to meet my deductible first, which is now $1000. a quick calculation showed the $443 box was a 4 month supply, so in a year, I’d be putting out likely another $1000 bucks for these items.

So this brings home what many others have known long before me– how haphazard, and inequitable the US health care system really is. The quality of care is not correlated to the medical needs, or a medical diagnosis, but a financial one, e.g. how comprehensive is one’s insurance. My costs are not based on a medical opinion, but an arbitrary insurance company decision, a bottom line of profit margin.

And I am not ready to burn something in protest. When it comes down to it, I have the means to pay for this, and I will. And there are people who pay a lot of bucks out of pocket for other life critical drugs.

But it brings home a larger truth, that a medical advance for diabetics like an insulin pump is not going to be available to the working poor who are lacking insurance, or reasonable insurance.

It just smells wrong. I had some naive assumption that insurance was there to support the best possible health care. Silly me.

3 thoughts on “Insurance Bite For Pump Supplies

  1. Alan

    This is a problem that you’ll find with different insurance companies. In Massachusetts we managed to get a state law passed that mandated insurance coverage for diabetes supplies.

    That took about 4 years of lobbying and hard work in the Massachusetts State House, but insurance coverage for various things has gotten a lot easier.

    I would appeal it with Humana and ask Medtronic to help you with this one. In the past I’ve seen test strips coded a DME, but sometimes if you get hold of the right person at your insurance company you can change their mind.

    Alternately when you next have open enrollment where you work look to see what other insurance companies you may have access to. Right now I’m using Aetna and they’re fairly good.

    Good luck and be patient.

    Bernard

  2. Mandated insurance is a great cause; but that’s not the situation. Our Arizona legislation has the same mandate, but pretty much gives the Insurance companies an open book on how they can charge us:

    Nothing in subsection P of this section prohibits a medical service corporation, a hospital service corporation or a hospital, medical, dental and optometric service corporation from imposing deductibles, coinsurance or other cost sharing in relation to benefits for equipment or supplies for the treatment of diabetes.

    http://www.azleg.state.az.us/ars/20/00826.htm

  3. Yeah,
    Now the next big expense is CGMS. I gotta have one. You probably feel the same. I’m financially comfortable, and I know that a continuous glucose monitoring system would benefit my health, but the expense gives me pause, especially knowing that the insurance companies will eventually pay for it. They are just delaying as long as they can to preserve profits.
    Insurance is the business of taking people’s money and stowing it away for when they need it, then telling them why they can’t have it when they do.
    I never think that I am getting something for free when my insurance pays for it. I figure I payed, one way or another.
    The insurance business is very profitable, but it is a lousy healthcare system.
    It’s about time we realized this system is not working. Well, I think most people have realized that.

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