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New Insurance scared to death!

Discussion in 'Parents of Children with Type 1' started by keitrat, Oct 15, 2016.

  1. keitrat

    keitrat Approved members

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    My husband currently has cheaper insurance through his employer which is Anthem. We currently have Cigna through my employer which is a bit costly but I know Dex and pump are covered. I am scared out of my mind to switch and there be an issue with DD getting supplies for pump and Dex. I have heard so many horror stories of insurance companies giving people the run around or saying Dexcom is luxury! Is anyone familiar with Anthem and the process? Think I should just stick to what I know and just suck of the cost! Any suggestions!!!!!!
     
  2. jenm999

    jenm999 Approved members

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    This should not be a mystery! It's not the insurance company that determines coverage per se; it's the policy your husband's employer has purchased that determines what is covered and at what percentage. In fact, it may be cheaper only because his employer pays more of the premium. I would not rule it out - he should contact HR and get the schedule of benefits, and call Anthem directly (with your employer info handy) if you are unsure.

    That said, Dex is non-negotiable for me too!!!

    Good luck.
     
  3. Lakeman

    Lakeman Approved members

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    Additionally, if you pay less for the insurance then you can put all the saved premiums toward dex supplies.
     
  4. Just Jen

    Just Jen Approved members

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    I agree that every plan is different and each employer's coverage will be unique. That said, when my daughter first got her Dex and her pump, we were covered under Anthem. It isn't that they won't cover it, the question is how much of it is covered, and how much will you need to pay. The plan we were on, because we met the deductible previously, they covered the Dex and the supplies at 90% and we paid 10%. But the plan we are on this year, after meeting the deductible, they cover at 80% and we pay 20%. As I said every plan is different. It can pay off to do your homework and create a spreadsheet with all the possibilities to compare prices.
     
  5. Snowflake

    Snowflake Approved members

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    Agreed. We've had Anthem insurance in two different states (TX and CO) under two very different plans. Right now, we're in a narrow network HMO with 100% diabetic supply coverage after a $250 deductible. On our Texas plan, memory is fuzzy but I think it covered the CGM at 80/20 after a pretty hefty deductible.

    On the larger question, my impression is that CGM insurance coverage, at least by major private insurers in the United States, has become more or less standard in the past few years. Some insurers require a little more paperwork justification than others, but I hardly ever see stories of outright denial for CWDs these days.
     
  6. sarahspins

    sarahspins Approved members

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    Yes, sometimes you'll see denials, but it's usually a case where they'll cover it under Pharmacy and not DME, or the other way around. Occasionally "something" get messed up on the paperwork and a patient ends up listed as a T2, but most seem to cover them without much hassles for T1's.
     
  7. Lakeman

    Lakeman Approved members

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    So now that some time has gone by...how did it work out?
     
  8. keitrat

    keitrat Approved members

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    Thanks everyone, we have decided to stick with what we know and that's Cigna. I have a fear of the unknown and can't imagine being denied for a cgm for even the shortest length of time.
     

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