What do you think of this insurance coverage? Opinions, please.

[thebestnest5]

PPO plan
Prescriptions $75.00 deductible per individual, after that 80/20, monthly.
--Insulins being $80-100 per bottle, retail not co-pay cost
--test strips being around $100 per 100 strips, retail not copay cost
--glucagon being $100.00 per kit retail

DME has a $500 deductible per individual & $1000 per family
$3000 maximum out of pocket per year
no DME maximum on plan for supplies

Dr. visits are 80/20 or 70/20, depending on Dr. after the $500 deductible is met.

Insulin pump coverage is 70/30; but has to be preapproved and they pro-rate their payments over 12 months. If you buy it, they wouldn't re-imburse you all at once...you would get 1/12 of the amount for 12 months.

No alcohol, ivprep, betadine wipes covered
Numbing cream not covered under DME or MMS...maybe under pharmacy
No tapes of any kind covered
No lotions/creams covered

Infusion set and resevoirs are covered under the 80/20 or 70/30 (depending if they are Preferred) and after $500 is met.

and...
Cost of $150.00 per month from employer plan.

[Ellen]

$150 per month sounds really reasonable - we pay about 10x that.

[BrendaK]

It sounds like you get what you pay for. $150/month for a family is very very inexpensive. (Is that $150 for the whole family?). But the coverage is pretty minimal. Not the worst in the world, but not great.

When you listed prices for the insulin and test strips -- is that what you have to pay, because that's about full price.

[saxmaniac]

At first glance it looks good to me, it's cheaper than what I pay! You might get less costs with a lower-priced POS plan, with less choice of doctors. But a PPO (no-referral) really doesn't help with D unless your GP refuses to refer you to a endo you want to keep. It's pretty easy to go GP shopping!

Another major factor to consider would be whether you have a cafeteria plan, which can really cut down the cost of copays, OTC stuff, travel expenses, etc.

What other choices do you have?

[thebestnest5]

$150 per month sounds really reasonable - we pay about 10x that.

Ouch!:eek: Do you have an employer plan?

[thebestnest5]

It sounds like you get what you pay for. $150/month for a family is very very inexpensive. (Is that $150 for the whole family?). But the coverage is pretty minimal. Not the worst in the world, but not great.

When you listed prices for the insulin and test strips -- is that what you have to pay, because that's about full price.

That's full price per bottle and per 100 strips.

[thebestnest5]

At first glance it looks good to me, it's cheaper than what I pay! You might get less costs with a lower-priced POS plan, with less choice of doctors. But a PPO (no-referral) really doesn't help with D unless your GP refuses to refer you to a endo you want to keep. It's pretty easy to go GP shopping!

Another major factor to consider would be whether you have a cafeteria plan, which can really cut down the cost of copays, OTC stuff, travel expenses, etc?

What other choices do you have?

Not sure on the other choices, yet. I need to do some more checking. I am not impressed that they do straight percentages and not fixed dollar co-pays.

Where are the insurance plans that have $0 co-pays on insulin and cover pump supplies 100%? The plans that actually cover tapes and other supplies?

[Brensdad]

I'd have to do the math, but based on what you have presented here, I would think you'd be better off paying out of pocket or buying strips on Ebay because those coverages are not very good at all.

At $150 per month for 12 months, that's $1800. That will buy you 900 test strips alone. Then you can buy insulin for only a few more dollars per vial with no deductible (which adds $6.25 per vial assuming you use 1 vial per month). I think at retail fast-acting insulin is $88 per vial (Drugstore.com), and so your insurance isn't saving you anything on insulin.

Pump supplies are a whole other story, and I don't have enough details to work it out.

With doctor visits, if you will tell them you are paying cash they will give a BIG cash discount if you pay at the time of visit. Check with the endo's office on that one.

My insurance is through UnitedHealthCare, and we pay zip except for 10% on pump supplies (which is why we use A+).

All that being said, it is a PPO, so have you tried A+ yet?

[momofsingingdiabetic]

We have a PPO and are paying $20 for reg dr, $40 for specialist. Prescriptions are $10/20/35 depending on what they are (insulin is $20). Ours is a PPO (BCBS) and I really like the coverage we are getting. We do have to pay 20% for pump supplies which is why I tried A+. Ours is also a little more than $170 a month for family coverage...(did I mention how much I like my DH employer). These actually just went up yesterday.... (why would someone pay $100 for ER visit for sinusitis when an Urgent care visit was only $30??? have not figured that out yet)... abuse of the insurance by some of the salaried people has all of our copays and deductibles.

I would keep looking around to see what else they offer.

[funnygrl]

Is the pump percentage based on the cost the insurance has negotiated with the pump company? For example, Minimed's list price is like $6,200, but they have a negotiated price of $4,600 with my insurance, so 30% of $4,600 is a big difference from 30% of $6,200.

[thebestnest5]

Is the pump percentage based on the cost the insurance has negotiated with the pump company? For example, Minimed's list price is like $6,200, but they have a negotiated price of $4,600 with my insurance, so 30% of $4,600 is a big difference from 30% of $6,200.
I don't know what their cost is; but our current insurance negotiated just over $5000 for the Minimed and 80/20 coverage.

[Ellen]

Ouch!:eek: Do you have an employer plan?

Apologies. I was WRONG. I just checked with my husband. Last year we paid about $600 per month for insurance but that included medical, dental, and health care reimbursement for a family of four. We have no deductible, pay 25% but up to $55 per prescription for 3 month supply, pay 25% copay on DME and doctor's visits (25% of the negotiated rate)...but if we go out of plan it's about $1500 per person deductible so we stay in plan. So although the plan was $600 per month (it went up in 2008 but we haven't been charged yet for the first payment), we still spend a fair amount out of pocket for the copay on supplies and meds and appointments with physicians.

[Momof4gr8kids]

That seems like a good price. Have you looked at other plans, or HMOs? We were paying privately for an HMO with 80/20 and $1000 deduct, No co pay on durable medical, and script co pays were $20 for name brand and $10 for generic, and that included eyes, glasses, and contacts for around $250 a month. I miss Utah for that reason and would kill for those rates again. Utah is a great state as far as health insurance prices go, but if you are not covered it will cost you.

[thebestnest5]

That seems like a good price. Have you looked at other plans, or HMOs? We were paying privately for an HMO with 80/20 and $1000 deduct, No co pay on durable medical, and script co pays were $20 for name brand and $10 for generic, and that included eyes, glasses, and contacts for around $250 a month. I miss Utah for that reason and would kill for those rates again. Utah is a great state as far as health insurance prices go, but if you are not covered it will cost you.

It's actually not a plan in Utah. Our plan in Utah is a little better coverage.

[twodoor2]

We pay around $140/month for BC/BS through my husband's employer who covers a big chunk of his health care insurance. However, they pay 90% after each deductible ($200 per family member). We do not get well-check coverage for the kids, nor vaccination coverage (some vaccines are covered through the state health care program, but not the expensive ones). We have a maximum of $3000 out of pocket, and they paid for most of the pump (all but $700 worth). I use A+ and everything is free, and there is no maximum of supplies covered as long as the doctor prescribes them. The only thing is with the baby, he goes for so many frequent well-checks, it is expensive. We can also choose any doctor we want.

[Tori's Mom]

Where are the insurance plans that have $0 co-pays on insulin and cover pump supplies 100%? The plans that actually cover tapes and other supplies?

I don't know of any "insurance plan" that covers EVERYTHING at 100%.
You will see a lot of us talk about A+ medical supply and not having to pay for anything including the tapes, alcohol wipes etc. BUT, A+, if you look at your statement from your insurance, charges for these things but usually does not get reimbursed for some of them. They just eat the cost and accept the reimbursement they get for the other supplies that are covered.
Does that make sense? AND, they charge your insurance company enough for the covered supplies so that they are not making you pay the deductibles/copays.

[thebestnest5]

I don't know of any "insurance plan" that covers EVERYTHING at 100%.
You will see a lot of us talk about A+ medical supply and not having to pay for anything including the tapes, alcohol wipes etc. BUT, A+, if you look at your statement from your insurance, charges for these things but usually does not get reimbursed for some of them. They just eat the cost and accept the reimbursement they get for the other supplies that are covered.
Does that make sense? AND, they charge your insurance company enough for the covered supplies so that they are not making you pay the deductibles/copays.

I use A+ (diabetic assistance program) with my current HMO. I was referring to some insurances that pay a different rate for insulin, so there is no charge for it. My current insurance covers tapes/Sween Cream/Numbing cream. A+ only gets paid the maximum my insurance would pay any diabetic supply company---it doesn't matter what A+ charges...my insurance company will only pay up to a certain dollar amount. A+ only sends items that I have coverage for; A+ gets reimbursed for all the items in my order. After our maximum out of pocket was spent due to buying the pump; A+ was reimbursed by my insurance company at 100% instead of 80%.

The insurance (in my original post) that I was questioning is not my current coverage.

[liasmommy2000]

Where are the insurance plans that have $0 co-pays on insulin and cover pump supplies 100%? The plans that actually cover tapes and other supplies?

In our case we have BCBS (HMO) but a special plan just for the university I work for. They have it so all DME (pump, pump supplies, lancets and test strips) are covered 100% as are insulin and syringes. And for the time being they are testing out a program that will end in six months where they cover at now/low cost other oral drugs and those that help prevent/control complications. I think that means cholesterol lowering drugs etc, though I'm not sure. For us that means we only have a copay for glucagon kits.

Right now with the cost of gas (I have a long commute) and childcare etc I would be losing money if not for the insurance. BUT....dh is self employed so I feel extremely lucky for this job and it's insurance. I knew it was great, but I had no idea until Lia was diagnosed.

[funnygrl]

I was thinking about this last night, and unless you otherwise qualify for some sort of free insulin program, the money you would save on insulin and test strips alone (assuming you use 2 bottles and 200 strips) would well over pay the $150/month.

[thebestnest5]

I was thinking about this last night, and unless you otherwise qualify for some sort of free insulin program, the money you would save on insulin and test strips alone (assuming you use 2 bottles and 200 strips) would well over pay the $150/month.

Exactly, and we use more supplies than that. Liv has been getting 6 bottles of Novolog and 500 strips per month.

So, we'd being paying a lot more. Insulin which costs us $25 per prescription now, would be around a $100 per month for Novolog and the strips would be around $100 per month. Even if we only got 4 bottles of Novolog and 350 strips, it would be close to the $150.00 per month. Now, that does not include pump supplies.:( Makes a person wonder about a promotion if their insurance changes and they now owe hundreds of dollars more per month for the same supplies. Not to mention that sensor coverage pre-approval/appeals start all over again.

And then again, I do know that there are others who don't have insurance and I really should be thankful.

[sammysmom]

My insurance covers everything at 100% no co pay, no deductible. The insulin is also covered at 100%. The insurace plan also cover the iv3000 tape. I have an HMO and will NOT be switching to a different insurance plan during open enrollment.

[jdr]

WE Have BC/BS Though my employer,we pay around $160 per month,with $25 copay on DR.visits. We have a $200 Deductable on meds. and 80/20 after that. We get a small discount on meds at the pharmacy.Not the best Ins. out there but I think it's pretty darn good. I do not agree with the comment about being better off paying out of pocket,for the very reason that if you think about just having to make one trip to the hospital,that would be a pretty big bill to pay if you didn't have ins. That.s not to mention if you had to stay several days,or had some major surgery done.

[OSUMom]

Our monthly portion for our family of 4 is $359 and continues to rise (BCBS PPO). Our son's pump was covered 100%. I'm not complaining.

$150 seems incredible.

[wilf]

I know this is slightly off-topic, but this thread freaks me out a bit.

Up here in Ontario, Canada we pay for supplies (strips, insulin etc.) out of pocket but we also get about $300 per month from the government to defray costs of having a child with a chronic illness - which is how diabetes is classified. Strips cost a bit less (I can get 100 for the Accucheck Aviva for $75 if I shop around).

The province (Ontario) is providing free pumps. Dr/endo/hospital visits are also free, as is treatment for complications.

It is hard to think that there are folks with Type 1 diabetes including children in the US who will not get the level of treatment they need because their families don't have adequate insurance and/or can't afford it. Your country is rich enough - this needs to be fixed..

[saxmaniac]

My home state (MA) is starting along these roads, making insurance mandatory. Time will tell if it actually works and makes it way to the "red states" someday. MA is less conservative than many other states.

[jdr]

I know this is slightly off-topic, but this thread freaks me out a bit.

Up here in Ontario, Canada we pay for supplies (strips, insulin etc.) out of pocket but we also get about $300 per month from the government to defray costs of having a child with a chronic illness - which is how diabetes is classified. Strips cost a bit less (I can get 100 for the Accucheck Aviva for $75 if I shop around).

The province (Ontario) is providing free pumps. Dr/endo/hospital visits are also free, as is treatment for complications.

It is hard to think that there are folks with Type 1 diabetes including children in the US who will not get the level of treatment they need because their families don't have adequate insurance and/or can't afford it. Your country is rich enough - this needs to be fixed..

I agree,but are problem is our pres. is more concerned about spending money elsewhere instead of focusing on our current issues here in our country.He has been given two bills this year that would aprove healthcare funds for poor children,and he slap a veto on both of them:mad:Have you checked to see if American Diabetes Wholesale will ship to your county? They have test strips for half the price.