Would have been nice to know from start....

[khannen]

I spent over an hour on the phone this morning trying to get all of our supplies in order. It started with me calling Abbott to see if I could get a Precision Xtra meter from them. I had remembered reading on here that a few people got one just for asking. I want one so we can start using the blood ketone strips.

I explained to the rep that our insurance will pay for the ketone strips, but won't cover the meter and that just didn't make any sense to me! She set up a 3 way call to Cigna and talked to the rep with me. Dang, I'm glad she was on the line as SHE knew all the right things to ask. lol... It turns out that I shouldn't have been paying a single dime for ANY of our supplies since her diagnosis in February. We have 100% coverage with absolutely no copays or deductible on all 'durable' medical goods through the medical part of our policy. Apparently everything had been filed under the pharm. part originally, even when I had gone to the mail-order with them to lessen my cost. Well now wouldn't that have been nice if someone had actually volunteered that info on one of the dozen or so phone calls I've made since February??? ARgh....

THEN she set up a 3 way call to a supply company and waited until we got everything set up and ready to ship. I will now get an automatic shipment of the following every 3 mths....

17 boxes of freestyle strips
1 box of Precision BG strips (as a backup meter)
SkinTac wipes
TacAway wipes
6 boxes of ketone strips (yahoo!)
9 boxes of multiclix lancets

They are also sending me the precision meter and an Accucheck Multiclix lancing devide. I had heard about it so much here that I wanted to give it a try. I planned on asking at the Endo's office next month. Pump supplies are already taken care of. Now we've gone from paying roughly $150 a month in supplies to not a penny. The only thing left is the insulin which costs us $60 for 3 mths through Mail-order. I would kiss the ground Juanita, the Abott rep, walked on if I was ever to meet her in person! She's my new best friend. The timing of all this was perfect as we just recently took a major paycut.

[Nancy in VA]

Congrats Kaycee. We have CIGNA too. Which Medical Supply company did you use ? We have been happy with Edgepark so far and they even carry the 2 meters that I am leaning towards.

I have had big hassels in the past with the difference between pharmacy and "medical" coverage - and mine kept resulting in benefits denied, saying it was the other, until I got the 3 way call going and got it resolved.

[Mrs. Russman]

yeah! that is great news for you. It would have been nice to know sooner, but isn't it great to know now. Very happy for you.

[Jensmami]

Yeah, good for you - congrats!!!:)

[Lee]

Since it was the insurance company that made the mistake, you SHOULD get all of that $ back. I would ask them about this!

[BrendaK]

Yes, you should get your money back. They can resubmit the claim correctly this time. Definitely ask about it.

[Tori's Mom]

I'm with the others....I'd be asking for reimbursement for past monies paid.

[marillyn]

Hi, I too have cigna. Please tell me how you were able to get them to cover the strips etc. They are telling me they are not under "durable medical goods"
Any help would be greatly appreciated!!! I have been ordering through the pharmacy for over a year.

[momofphoenix]

I agree you need to get your money back
I had the same problem and when I called and the rep said they could either send me the money back or use it for other rx's I told them I didnt need another savings account and and they could send my money back I got a 1000.00 check by overnight mail the next day :D

[Mama Belle]

Hi, I too have cigna. Please tell me how you were able to get them to cover the strips etc. They are telling me they are not under "durable medical goods"
Any help would be greatly appreciated!!! I have been ordering through the pharmacy for over a year.

We have CIGNA too and they have never been covered under DME. We are limited to 300 strips every 23 days, that's the best we can get, with overrides.

[Nancy in VA]

Hi, I too have cigna. Please tell me how you were able to get them to cover the strips etc. They are telling me they are not under "durable medical goods"
Any help would be greatly appreciated!!! I have been ordering through the pharmacy for over a year.

Which strips are you trying to get covered - BG or Ketone. The BG strips are a "pharmacy" benefit - you can do it through a local pharmacy or a mail order. You will have your pharmacy co-pay for those. Blood Ketone strips are a DMG. I had a big fight with them as they kept saying pharmacy-medical-pharmacy-medical and initially denied the billing from the medical company until I got both departments on the phone and agreed which it was and they called the medical supply company back and authorized it.

I call CIGNA 2-3 times when I want an answer because I never get the same one - I like to get 2 or 3 and compare. As of right now, I have been told under MY policy they will cover a pump and CGMS at 100% through Edgepark Medical Supply company.

[Mama Belle]

I call CIGNA 2-3 times when I want an answer because I never get the same one - I like to get 2 or 3 and compare. As of right now, I have been told under MY policy they will cover a pump and CGMS at 100% through Edgepark Medical Supply company.

HA!!! Don't count on it! I was told the exact same thing, wasn't true. I was covered 100% but not through Edgepark. Edgepark doesn't even have a contract with CIGNA ... call them! I finally had to go through the Pump reps to get the right info about pump coverage. They do this all day long and know the right questions to ask and with whom they should be speaking.

[MomofConor]

Which strips are you trying to get covered - BG or Ketone. The BG strips are a "pharmacy" benefit - you can do it through a local pharmacy or a mail order. You will have your pharmacy co-pay for those. Blood Ketone strips are a DMG. I had a big fight with them as they kept saying pharmacy-medical-pharmacy-medical and initially denied the billing from the medical company until I got both departments on the phone and agreed which it was and they called the medical supply company back and authorized it.

I call CIGNA 2-3 times when I want an answer because I never get the same one - I like to get 2 or 3 and compare. As of right now, I have been told under MY policy they will cover a pump and CGMS at 100% through Edgepark Medical Supply company.

I have Horizon BCBS NJ and they consider BG testing strips DME. They are not reusable, so I don't understand how they can classify them as durable? I am going to call, now that I see so many are getting them covered under pharmacy. These insurance companies seem to be experts at denying or offering LITTLE coverage when they want! Makes me nuts. I am going to have to fight them, I can see that now.

[momofsingingdiabetic]

We put our first order in with Edgepark and it was shipped yesterday. Three month supply of everything and our part was only $220. I almost pay that in test strips each month, so I think this is going to be cheaper for us. We'll see when I have the statements side-by-side and see.

[Nancy in VA]

HA!!! Don't count on it! I was told the exact same thing, wasn't true. I was covered 100% but not through Edgepark. Edgepark doesn't even have a contract with CIGNA ... call them! I finally had to go through the Pump reps to get the right info about pump coverage. They do this all day long and know the right questions to ask and with whom they should be speaking.

I have called CIGNA twice and confirmed that I can order from any medical supply company they have a contract with. I specifically asked about Edgepark. I have ordered other DME from Edgepark with CIGNA in the past 60 days and they have pumps in their catalog. So what am I missing?

[Mama Belle]

I have called CIGNA twice and confirmed that I can order from any medical supply company they have a contract with. I specifically asked about Edgepark. I have ordered other DME from Edgepark with CIGNA in the past 60 days and they have pumps in their catalog. So what am I missing?

I am just telling you what I was told by not only Edgepark but also by the Pump Rep. CIGNA swore up and down (several phone calls gave me different results, some sent me to Edgepark, some sent me to different medical supply company) that my pump was covered 100% through Edgepark. But when I called Edgepark I was told that they did not have a contract with CIGNA for insulin pumps and that they could not provide me with any information about my coverage since they were not contracted with them, I spoke with a supervisor at Edgepark who told me the exact same thing. At this point I finally gave up and had the pump rep call, they confirmed that the pump was not covered through Edgepark. Could be things have changed since then (this was back in March), but I just wanted you to be prepared that if you called Edgepark directly you might get a very different answer.

We did get the pump and pump supplies covered 100%, but not through Edgepark. This process was a total nightmare, I was told many different things every time I called. The pump rep had me an answer within minutes.

[Nancy in VA]

We did get the pump and pump supplies covered 100%, but not through Edgepark. This process was a total nightmare, I was told many different things every time I called. The pump rep had me an answer within minutes.

Where did you get it?

I just put in a call to Edgepark and they initiated a "pump authorization" process to see if its covered.

I agree that CIGNA is a pain - which is why I call several times to get answers. And we haven't even chosen our pump yet, I just knew it would be a problem so I started.

[Mama Belle]

Where did you get it?

I just put in a call to Edgepark and they initiated a "pump authorization" process to see if its covered.

I agree that CIGNA is a pain - which is why I call several times to get answers. And we haven't even chosen our pump yet, I just knew it would be a problem so I started.

We got it straight from the pump company. I called the Deltec (Cozmo Pump) people, they called CIGNA, they called me back immediately with news that we were covered 100% through CIGNA. They said they had to wait on CIGNA for the final authorization, which we got about 2 days later. We had the pump by the end of the week.

Edgepark told me the same thing about initiating a pump authorization and I was told I would get a call back within 48 hours. I never received a call. So when I called back I was told that they had no contract with CIGNA for pumps and that they have this problem with CIGNA all of the time. The supervisor told me that they had recently had a conference call with CIGNA about this issue because their customer service reps kept giving out erroneous information to their customers about obtaining pumps through Edgepark. Maybe they were feeding me a line of BS, but I would think that they'd want the business if it were covered through them. Again who knows if it has changed. CIGNA has been a nightmare to deal with when it comes to the pump, so I just didn't want someone else to deal with the same run around I dealt with. ;)

[Nancy in VA]

We got it straight from the pump company. I called the Deltec (Cozmo Pump) people, they called CIGNA, they called me back immediately with news that we were covered 100% through CIGNA. They said they had to wait on CIGNA for the final authorization, which we got about 2 days later. We had the pump by the end of the week.

Edgepark told me the same thing about initiating a pump authorization and I was told I would get a call back within 48 hours. I never received a call. So when I called back I was told that they had no contract with CIGNA for pumps and that they have this problem with CIGNA all of the time. The supervisor told me that they had recently had a conference call with CIGNA about this issue because their customer service reps kept giving out erroneous information to their customers about obtaining pumps through Edgepark. Maybe they were feeding me a line of BS, but I would think that they'd want the business if it were covered through them. Again who knows if it has changed. CIGNA has been a nightmare to deal with when it comes to the pump, so I just didn't want someone else to deal with the same run around I dealt with. ;)


Don't get my wrong - I absolutely appreciate it. Today I took the name and date of the person I spoke with. And, Edgepark hasn't been good about ever calling me back but I tend to get ok results when I call them back myself.

I'll keep calling until next week. Next week we have pump night where we see all the pumps and make a choice. I will carry all my insurance contact information and any companies that I have been told "might" be able to supply the pump and let them take it.

Incidentally, my CDE has said that Cigna is a pain to work with. She was getting the run around with them regarding the Insuflon and I finally took over the calling (because she just didn't have enough time in her day for the run around) and after call after call we were told Edgepark (which of course, we weren't told for the first 4 calls - the first one directed us to a company that didn't even SELL the product we were calling about). The CDE is convinced this is all a process to "push us down and discourage us" so that we'll just give up and stop pursuing what it is that we want. Won't be happening here, my friend!

[Illinifan]

Definitely inititate the paperwork to get your money back.

Your cost for insulin runs $60? Holy cow!!! Insulin is a covered medication for us so it's free at the base pharmacy, but if we went to a civilian pharmacy, it would only be $3 each for a month's supply.

[Lizzy731]

This happened to me but I called the insurance company from the hospital because I could not believe that I had to pay out of pocket for all of the supplies that we required before taking Bethany home (the insulin & the glucagon were the only things that were covered from the pharmacy). And we found out just like you that it was covered under the medical portion of our insurance and not the pharmaceutical portion. I got reimbused for everything after much investigating. They did not want to make it easy for me at all. So get your money back!!

[khannen]

Okay... so 4 days later I'm still battling this. Lmao....
I have even talked with supervisors who contradict each other. I've been told so many things now that I can't even type them to keep them all straight! Lol I have no idea what will be covered under WHAT anymore, but I do know that I'm still pretty lucky with what our original benefits were. I pay $60 for a boatload of Novolog... hmm 6 bottles maybe? I also pay $60 for 750 Freestyle strips. It's not the best, but I'll take it!!

Nancy- I ran into the same thing for Edgepark. One Cigna rep sent me to them and now I've been told they aren't contracted with Cigna. Lol. I even had an Edgepark supervisor tell me he wouldn't be able to help me unless I paid out of pocket. Who knows... if it works for you and the bills are being paid, don't complain.

Now it has become almost a game. Hmmmmm.... what will they come up with this time? I haven't asked about the ketone strips being durable Nancy. I'll have to try that tomorrow.

[Mama Belle]

I ran into the same thing for Edgepark. One Cigna rep sent me to them and now I've been told they aren't contracted with Cigna. Lol. I even had an Edgepark supervisor tell me he wouldn't be able to help me unless I paid out of pocket. Who knows... if it works for you and the bills are being paid, don't complain.

Well, at least I am not the only one who had that experience. Preferrably I'd like for no one to have it, but at least there is some consistency.

[munsonklein]

I agree- CIGNA is a nightmare. I've had several suppliers tell me that CIGNA is one of the easier insurance co's to work with- I shudder to think what the others are like! We have never gotten correct information through a phone call to them, even when the doctor's office called for us. My husband was originally sent to Edgepark by them as well when we started the pump process. Several weeks and many phone calls later, Animas finally gave us the correct info- Gentiva was the "middleman" for our pump purchase. Maybe CIGNA uses different contractors for different parts of the country? We are in upstate NY.

BTW, you should be able to look up at least some of the details of your policy at www.mycigna.com. I've gotten most of my answers from the website- I find calling CIGNA to be pointless.

Did they actually cover the CGM? Last I new they still weren't, but I know they have an annual review of new products every July and I haven't checked since then.
Cathy