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G4 insurance contracted cost?

Discussion in 'Parents of Children with Type 1' started by mmgirls, Feb 27, 2013.

  1. mmgirls

    mmgirls Approved members

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    We have new insurance this year and ordered the new G4 last year on the old insurance.

    Cigna's contracted in-network cost from Edgepark
    is get this: $524.97 for 1 box of 4 my cost $78.75

    United's contracted in-network insurance cost was $308 last year when I upraded, my cost $46.20

    I am just curious what others are paying right now for the G4 sensors, thank god we normally get 10-14 days out of them.
     
  2. Sarah Maddie's Mom

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    I'm reminded that I need to be thankful that our supplies are 100% covered. The premiums are monstrous, but the benefits are good ;)
     
  3. mmgirls

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    I miss the days of 100% coverage, I did not care what the contracted cost was 5%, 10% did not care too much but now that we are up to 15% co-insurance it makes a difference.

    ON PAPER the insurance coverage looked comperable, but you don't get to see contracted costs for DME items.
     
  4. Mish

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    This was for 3 boxes. (billed, covered, and I paid 15%)

    Sensor; invasive (e.g. subcu (A9276) 2,249.85 1,574.90

    So tricare paid about $524 a box. I wonder if they contract a different rate with each DME? I never had to pay for anything before, (premiums either) and all things considered, $150 deducible and a $1000 FAMILY cap per year with a very low premium is still worth it, all things considered.

    EDIT...I just realized this was for 3 boxes, not 2. Just edited the whole thing.
     
    Last edited: Feb 28, 2013
  5. mrcool

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    We get sensors directly from Dexcom, and our insurance (BCBS of MI) paid them 1,085.28 for 3 boxes of sensors (we normally pay 10%, but had reached the cap in December, so the sensors were "free" for us. The original charge from Dexcom was 1,380.00 for the 3 boxes. So the initial charge from Dexcom was 460 dollars a box and our insurance paid them roughly 360 per box.
     
  6. mmgirls

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    thanks for the info guys.

    I am scratching my head a bit here because I don't understand how an insurance company contracts for a cost higher than the "cash cost"

    I just got off the phone with Liberty and the cash cost is $249.00 for a box of 4 sensors waiting for the Cigna cost; and with a company called Solara the cash cost is $349.00 but Cigna's contracted cost is $380.00

    Tricare paid $787 and BCBS paid $360, scratching my head.
     
  7. mmgirls

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  8. ecs1516

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    We have United and pay $61 a box.
     
  9. mmgirls

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    but what is the "contracted cost"? I am sure that your $61 is a % of the cost.
     
  10. Jordansmom

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    Our contracted price is $308. Although our diabetes supply billed $980. What a screwed up system for all of us.
     
  11. mmgirls

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    Who is your supplier?
     
  12. Jordansmom

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    Utah Diabetes Specialty Center. I Know people outside of Utah using them. And I switched to them because I heard their Dexcom pricing was much better than Edgepark's.
     
    Last edited: Feb 28, 2013
  13. manda81

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    Maybe we should try again... our last attempt was for the Dex7, and we had no coverage until our 2500 deductible was met... which wouldn't happen until almost the end of the year, then they covered 80%. =/ So it was going to be like 280 a month, I think? All of our other diabetes stuff is covered at a pharmacy copay, and our Omnipod is covered 100% though.
     
  14. mmgirls

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    I have coverage they cover 85% of the $525 so I would pay $78 but I paid $46 last Decemeber from the same supplier.The only thing that changed was the insurance company contracted cost. I have not even dealt with other pump supplies just the G4 because that is what I need.

    But we can only afford higher prices until our FSA savings runs out, thankfully I increased it this year. But of course if i can get them cheaper then I want to. this all just putts us in a tighter place than I want to be right now and was a great surprise.
     
  15. denise3099

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    Do you have a different prescription/pharmacy insurance or a mail order pharmacy? If I order from Dex and go through my BCBS I pay 10% of whatever as dme. But instead I wanted to go through my mail order pharm medco/express scripts to pay a flat co-pay. Dex told me to call Foundation Care 877-291-1122. they were able to process my script insurance, sent the sensors out the same day and charged me 10 bucks for one box. Try and call whoever handles your pharm insruance or call Foundation Care and see if they can help by running it as a script instead of dme.
     
  16. mmgirls

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    thank you, I will call about it.

    This is new insurance and I am learning allot. I just don't want to make another phone call to "Shop around", it should not be this hard for my insurer to tell me who is the cheapest for the dexcom, why do i have to do all the foot work.

    I am just so flipping fustrated right now with insurance.
     
  17. mmgirls

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    OMG OMG OMG

    I LOVE YOU!!!!!!!!!!!

    I LOVE YOU!!!!!!!!!!

    I just got off the phone and they will cover the dexcom 2boxes for $15.00
     
  18. denise3099

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    LOL. I discovered the beauty of mail order pharmacy long ago before allegra was over the counter--pay 70 bucks for 1 month ate cvs or 10 bucks for 3 months through the mail. :eek: Now it's the first thing I ask about every med supply I buy--Can you charge it to Medco? That's where we get strips, alcohol, insulin, pretty much anything we can. So glad that worked out for you. :)
     
  19. mmgirls

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    on our old insurance we couldn't do it, i guess i can with this new one.
     

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