I'm trying to understand how pumps and cgms work and how they are covered with insurance. We are 3 months into D (Oct 26, 2011) and are on MDI. We have Tricare Prime North. I would like to talk to our endo about getting a pump. If there is anyone who can help me, here's what I would like to know:
1. Does tricare cover all 3 of the major pumps (Medtronic, Animas and Omnipod)? (I did call them but they didn't specify that they only approve a particular pump.)
2. Is the pump considered DME and everything else pharmacy? Or are the sets and pods considered DME and only insulin pharmacy? Is there an annual cap for supplies?
3. Is it hard to get approved for a pump? Or did it take multiple times? How about for a cgm? (He drops into the 50's!)
4. How does coverage change once he retires in 2 years? Do we pay more out of pocket?
5. Understanding pumps, are the "sets" the tethered part that stays in him and connects to the pump itself? And many different companies make them not just the pump companies? Is there an application piece that gets removed or is it all one piece?
I know this is a lot. I have tried to do the research myself before posting this, but I just couldn't find specific answers. I looked on the tricare website, but everything is so generic.
Thank you all so much for helping me understand, even is you don't have Tricare.