View Full Version : DME vs Prescription or other
jules12
01-02-2008, 09:39 AM
I thought I read on here that someone said you could challenge your insurance on DME and could have your pump supplies come out of another category that didn't necessarily apply to deductible. If someone knows and could please post, I would appreciate it.
We have $1000 deductible to be met and then it is only covered 80/20. This past year, the pump supplies have come out of dme but because we had the intitial hospital bills, we met the total out of pocket (2500) and haven't paid for pumps supplies yet. I have not used A+ because we have a cap on our dme and I am afraid we would go through that so fast, we would really have a problem. Plus, we want to save the DME for a pump as well in 3 more years...so I keep that in mind.
Our insurance approves strips at 300/month for $35. Not the greatest but definitely better than what some have said.
This has been a tight year for us and we now have some dental bills to pay....I just hate dealing with insurance all together!!!
I would talk to your insurance about this - pump SUPPLIES are not durable or reusable and should not be included in that category.
momtojess
01-02-2008, 12:00 PM
Our pump was a dme, but all the supplies for it are billed as scripts for us.
Nancy in VA
01-02-2008, 12:41 PM
I would talk to your insurance about this - pump SUPPLIES are not durable or reusable and should not be included in that category.
Our insurance company calls all pump supplies DME too. But, I'm not fighting it because they cover DME 100% and I have co-pays for all my prescriptions - so the more they call DME is fine with me!
liasmommy2000
01-02-2008, 12:56 PM
Our insurance company calls all pump supplies DME too. But, I'm not fighting it because they cover DME 100% and I have co-pays for all my prescriptions - so the more they call DME is fine with me!
Same here, except I have no copays for anything D related except Glucagon kits. But non D prescriptions have copays. But ALL DME is covered 100% so I'm more comfortable with pump supplies being under DME coverage just in case things change.
Momof4gr8kids
01-02-2008, 01:01 PM
I think you'd have to find out what they define DM, and what they consider a script, and then go from there and see what grounds you have to challenge being billed under DM.
kel4han
01-02-2008, 01:16 PM
DISPOSABLE MEDICAL SUPPLIES
Some insurance companies cover disposable medical supplies on a different level. That would apply to infusion sets, resevoirs, needles, etc. Our insurance pays 100% for "disposable medical supplies" but they have denied all our claims as DME......working on fighting this....I can send them my month supply of used sets if they would like to see them as disposable :D
Nancy in VA
01-02-2008, 01:49 PM
DISPOSABLE MEDICAL SUPPLIES
Some insurance companies cover disposable medical supplies on a different level. That would apply to infusion sets, resevoirs, needles, etc. Our insurance pays 100% for "disposable medical supplies" but they have denied all our claims as DME......working on fighting this....I can send them my month supply of used sets if they would like to see them as disposable :D
DME actually stands for Durable Medical Supplies. Things that actually don't get "used up". So a pump would qualify as a DME, but many would argue the supplies to USE the pump aren't "durable" but many companies lump them together as "pump"
jules12
01-02-2008, 04:23 PM
Thanks for the info - I think I will start by looking into the cost of disposal medical supplies - if they aren't covered, I don't want to rock the boat and have them think they can get out of paying for any of it!
We don't have the best insurance but it is better than none and my company is extremely friendly about getting off for anything d related so if we can work out the expenses - it's worth it to keep the same job!
Thanks for the info!
sammysmom
01-02-2008, 08:38 PM
My insurance company got around this by stating that "all diabetes products will be billed under durable medical". So what they actually did way to give all diabetes supply a blanket catagory, which happens to be the durable medical equipment. I am not complaining, we are covered at 100% DME with no deductable or cap.
momofsingingdiabetic
01-02-2008, 08:44 PM
Ours is the same way too....all diabetes supplies are DME. I pay 20%, but no cap on coverage.... Our deductible just went up yesterday though, one reason I started talking to Aplus....
momtojess
01-02-2008, 09:08 PM
Our pump was a dme, but all the supplies for it are billed as scripts for us.
After I was talking to insurance today (about why we havent been approved or denied for the cgms) I found out Aplus is gonna be billing all of our supplies as DME. At first glance this isnt an issue as we dont have a yearly max, but we do have a $2,000,000 per person lifetime max of all coverage.
We havent recieved our first shipment yet. I looked and Jess has been averaginga bout $20K per year expenences, so I may try Aplus for awhile and if it seems off target then i may cancel. I love the fact it is no copay, but not at the expence that she may hit the life max too early