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NYS Insurance Advice?

Discussion in 'Parents of Children with Type 1' started by bellows, Jan 6, 2014.

  1. bellows

    bellows Approved members

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    Is there anybody in New York State who has any insights to share regarding insurance providers? I need to buy insurance on the exchange before we eventually get employer-based insurance, and the plans don't specify all the possible diabetes coverage needs. (e.g. are strips always considered 'durable medical equipment', or are they just a prescription item?) Before I pick up the phone and started grilling every single insurer, I thought i'd ask here and see if anybody else had any wisdom to share!
     
  2. BittysMom

    BittysMom Approved members

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    We purchase our insurance privately here in NY because my husband owns a very small business and I work part time. We had Oxford for years which was wonderful. These companies are now moving out of the private market and it would have cost us approximately $4K per month to hold on to it making it prohibitive. Our broker came up with Health Republic of New York. It's cheaper than Oxford at $1400/mo vs. $1900/mo for our family but the coverage is different and we'll pay more in other areas. I wanted details pertaining to whether our infusion sets and dexcom sensors were considered durable medical before I signed up because it seems there is possibly a cap there... We've been running into information roadblocks because these companies are brand spanking new and we had very few options anyway. We went with the platinum plan if I hadn't mentioned it. I'm currently trying to get my daughter's pump and Dexcom reapproved through this insurance so our supplies begin again. I have no idea how smoothly that will go and neither do their customer service reps because it's all new to them.yikes. I wish you luck and hope this was somewhat helpful. Another option we had was a new company called Oscar. Our broker directed us to Health Republic because he thought it had more stability being that Oscar was started by venture capitalists as opposed to being government backed as HR is. He did point out however that we're only stuck in this for a year and that's guaranteed regardless of whether a company folds or not. In your case it sounds like you don't need this coverage for long. Good luck. I miss my Oxford plan.

    Edited to add: both my broker and I repeatedly called HR to get specifics and the reps would just read off from the charts provided to us regarding coverage. I did provide codes and was able to glean that the actual pump and Dexcom units are durable medical. It's sounds like the supplies for them are as well but I was given different answers. I believe strips are covered at 100% but that's not knowing if I'll still be able to get the 300 a month I'm accustomed to getting through Oxford. We'll see.
     
    Last edited: Jan 7, 2014
  3. bellows

    bellows Approved members

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    Thanks! It looks like we may be able to exchange information once I get going...much to my semi-horror, it seems that the Berrie Center in NY only takes Oxford/United off of the exchange plans. And they're the most expensive! However, I have been able to figure out that I can buy Health Republic for myself and spouse, and put our daughter (the only diabetic in the house) on United/Oxford. I had the same reluctance about "Oscar"--the plans just seem weird. I'm waiting to hear back from the Berrie Center to find out if they expect to take Health Republic by Feb. 1, because if so, we might go with that for our daughter too.

    I really appreciate you sharing the information about the pump supplies and strips. Just from looking at the plans, it seems to me as if they'd be calculated as 'durable medical equipment', and thus subject to coinsurance on the Health Republic and Oxford/United plans, but you probably know better than I do.
     
  4. Megnyc

    Megnyc Approved members

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    Have you looked into Child Health Plus? I believe Naomi Berrie takes most/all of their plans. Your daughter should be eligible for it regardless of your income as long as you do not have employer provided health coverage. I believe the full premium is around $200 a month (if your income is less than 400% of federal poverty line you pay much less). The advantage of Child Health Plus is that there are no copays or additional costs other than the premium. Might be something to look into...

    We have had UHC/Oxford on and off for many years. In terms of insulin pump coverage it has been amazing. They have always approved pump supplies immediately and we had the choice of any of the available brands of insulin pumps as well as our choice of suppliers. Test strips have always been covered with a copay under prescription coverage or as diabetes supplies with a % coinsurance. We have always done whatever was cheaper since they give you the choice. I have Aetna right now and everything but insulin and the actual insulin pump can go through either rx coverage with a copay or DME with a % coinsurance.
     

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