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Any program to help with a high insurance deductible for a pump?

Discussion in 'Parents of Children with Type 1' started by jkrjk, Mar 20, 2014.

  1. jkrjk

    jkrjk Approved members

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    We have Blue Cross of TX and just heard we have met $20 towards our $5000 deductible. So for whichever pump we decide to get, its going to cost $5000 plus some. :( We own a small business and insurance is tricky I guess compared to working for a bigger corporation. Just thought I would check here to see if I am missing anything, or if any of you are aware of different programs available for people in this situation? Thanks so much for any tips or advice!

    Katie
     
  2. mmgirls

    mmgirls Approved members

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    Is that the individual deductible? or the family?

    Some pump companies can do 0% financing over the year. That is what I am thinking of doing, individual deductible is $1300 for her and if I get the pump first and have it financed and be put on a payment plan looks more doable than eating away at the deducible, then max out of pocket.

    Have you looked at you state individual/family plans with the "affordable care act"?

    Maybe some TX folks will ring in.
     
  3. nanhsot

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    Our insurance forced us to go through a DME company (Edwards Healthcare) and they have been truly awesome to work with. Very good communication and they allowed us to make a payment plan in our own time, with no interest at all. I would check with approved providers of your plan and see if any will allow you to pay it over time.
     
  4. Don

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    Maybe you can put off pump until you can switch to plan with a lower deductible?
     
  5. mmgirls

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    Omnipod also has a much lower starup cost and continuing cost because there are less pieces to the system.
     
  6. MyPumpkin

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    We too are self employed and for the previous two years we had Blue Cross Blue Shield of AZ with an individual deductible of $7500. We never tried to get the pump during that time because we knew we would have to pay all of it out of pocket and that was just not do able for us. This past year we changed insurances and have a much smaller deductible and have just gotten my son a pump. One thing that I did not know before was that you can make payments. We went with the Animas Ping. They had us put 20% down and the rest we will be making payments for the next 24 months. You also do not have to qualify for their payment plan. They did not do a credit check.
    They told us the total cost including 3 months supplies was just under $5000. So without any insurance help that would seem like you would need to put $1000 down then you would have monthly payments of $167 a month. That still is a lot but it may be easier then a big lump sum. But don't forget that you will still have the supplies. In our plan it is also under the DME and subject to the deductible. This year if you get the pump your deductible will be met but you also need to think about next year when your deductible starts again. I cant remember the exact amount but I think that the 3 month supply before my insurance pays anything, is going to be around $500.
    Just wanted to give you some numbers to help. Good luck. :)
     
  7. Melissata

    Melissata Approved members

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    The start up costs are low on the Omnipod, but the ongoing costs are high with, at $300 per month for pods. Over the 4 year period, the prices even out. I know that Tandem will finance a Tslim, and I think that the pump is less expensive than the others also.
     
  8. sincity2003

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    jkrjk - check your private messages.
     
  9. mmgirls

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    there is no way we would be able to pump if pump supplies cost us $300 a month. I think at the most average cost when we spent to most was around $150-200. we were blessed last year to have been able to get PODS and Animas pump supplies thru our pharmacy coverage with copay instead, and only spent $60ish dollars a month and stockpiled a bit and are now just starting to run out, right as my other dd is diagnosis. so back to looking for good coverage with two to think of.

    Right now I am looking to find a individual insurance coverage for my girl that still covers Dexcom under pharmacy, because it may just be better for startup costs to pay for individual coverage for her for a few months than take the hit with the high deductible.

    OP, maybe this could be an option for you too, get rates for an individual plan you your child.

    OP, the omnipod it is just the pods that you have to order, but with all other systems you need cartridges and infusion sites.
     
  10. ksartain

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    We also have BCBS and our DME (Edgepark) filed a deductible fee waiver for us so that we could get the supplies without having to meet the deductible. I don't know if they will do that with a different pump, but they did with the Omnipod. We went from $276 per month for the pods to $72 per month. And it is a lifetime deductible waiver, so you won't have to hit it or reapply every year with the pods. But it was only good for the pods. Anything else, like the CGM, had to meet the deductible.
     
  11. jkrjk

    jkrjk Approved members

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    So can you tell me more about this?! That would be huge! How did you get Edgepark to file that for you- just ask?
     
  12. mmgirls

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    interesting, we might HAVE to go back to using Edgepark for our DME supplies, so I will squirrel away that info.
     
  13. ksartain

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    Ask your DME if your insurance provider would consider a deductible waiver, then ask if your DME can file one for you. When we went through the pump process, Edgepark asked me if I wanted to pursue it. They were surprised BCBS hadn't already given me one, considering we had been customers of theirs for years before diagnosis.

    The rep I spoke with at Edgepark made it sound pretty commonplace to do them.
     
  14. jkrjk

    jkrjk Approved members

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    Really interesting… thanks for the heads up! I already have a call in to rep at Edgepark… just hoping he acts like this is commonplace too! You just got the pod in Oct, right, so this is pretty recent? Definitely pursuing this- thanks again!
     

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