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Pump research, United Health

Discussion in 'Parents of Children with Type 1' started by suzyq63, Jul 30, 2008.

  1. suzyq63

    suzyq63 Approved members

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    How do I find out which pumps are covered? United Health knows nothing! I haven't the slightest idea which pump we'd be interested in. Unfortunately it will depend on the insurance coverage. We're at the very beginning stage of research. Alison has been honeymooning for 6 months (something is currently going on - can't get her bg below 170 - it wants to stay around 200). The endo gave us a demo Omnipod yesterday and it has sparked Alison's interest in pumps.

    Does anyone have United Health and know which pumps are covered and how?

    Thanks.
     
  2. liasmommy2000

    liasmommy2000 Approved members

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    I don't have them but my insurance company didn't know either! Crazy! They gave me the names of some DME suppliers they use and supposedly carried pump supplies. They didn't know either.

    I called the endo's office and spoke to the CDE. She told me to ask the pump company (we already knew we preferred Animas). Animas got all the paper work from me and had it approved in no time.

    I met one little girl at Lia's camp last summer who works for the same employer as me and she had a Minimed. So I'm guessing ours covers at least those two.

    Anyway insurance can be a pain to deal with when it comes to the pump. I've always heard to let the pump company do all the legwork and it worked for us. So I would call all the companies and ask for their help.
     
  3. phil413

    phil413 Approved members

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    We had UHC when we got Anna's pump. We have since switched over to my husband's insurance. I can tell you that the Omnipod was out-of-network for UHC. That being said we were originally approved for GAP in-network coverage. However, when it was time to re-order pods they said we needed to submit another request for the in-network exception, we did and it was denied.

    Even covered as out-of-network, costing us a bit more, the Omnipod has definitely been worth it!
     
  4. KarenRI

    KarenRI Approved members

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    We had United when Nate got his pump in 2005.

    I had each pump company send us all their pump info by mail, then I had a rep from each company come to our house to give us a demo and a presentation. We liked this because we had a great deal of one on one time with each, and asked lots of questions.

    Things may be different now, but each company may require an OK to Pump approval from your Endo. Once they get that, each company can run the info by your health insurance co. to see if and how much they will cover.

    Good luck! My son LOVES his pump!
     
  5. MyAngelEmma

    MyAngelEmma Approved members

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    Hi Paula! We too have United Health Care and just finished up pump shopping. I know exactly how you are feeling regarding frustration with getting info from UHC BUT be persistant and you WILL get answers. That was our experience.

    The first time I cantacted them, the person didn't even have a clue what an insulin pump was. :eek: I called back again and got a very helpful gentleman that really went out if his way to get answers for me. This is what I found out: The pump and supplies are covered under Durable Medical Equipment. If you know the company that makes the pump they can tell you if they are listed as a Durable Medical Equipment supplier. They have a list. For example we knew that the Animas was made by Johnson and Johnson and the the MiniMed was by Medtronic etc. so the guy looked this up for us and was able to tell us it was covered.

    When we decided which pump we were going with(Amimas Ping), I called back to confirm coverage and check about the supplies and got someone who was totally "not with the program" so to speak. She couldn't help me at all without a "code". I asked for a supervisor to call me back and when he did got the coverage confirmation I was looking for. So just be persistant with them. The supervisor said the first person I talked with was just being lazy or hadn't been trained properly so if you don't get answers ask for a supervisor.


    There are several diffent UHC policies so everyones benefits are different depending on your policy. Ours will cover 80% of the pump leaving us to pay just over $800 out of pocket. It all depends on if deductables have been met and your individual policy.

    By the way, once we decided to go with Animas, they have been great handling all the insurance details for us and answering all our insurance questions, Thanks PAM!:)
     
  6. suzyq63

    suzyq63 Approved members

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    Thank you. I will try contacting the pump companies myself I guess. According to United Health, the durable medical equipment is subject to my $1,000 deductible (which we've met for this year). There is also a $2500 per year cap on DME. Is that even enough to cover a pump? Too bad money just didn't grow on trees!

    I can't believe how interested Alison is in a pump right now. She will have to actually see one and try out an insertion set before making any pump decisions. Her language issues make it too difficult for her to fully comprehend, so she needs actual firsthand experience.
     
  7. Brensdad

    Brensdad Approved members

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    We have UHC, and I know that both MM and Animas pumps are covered. We also have the $2500 DME cap, but since they cover all the other stuff so well I am not complaining!

    The pump companies will take that $2500 and then bill you monthly for the rest, so don't sweat it too much.
     
  8. iluvmhp

    iluvmhp Approved members

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    We have united healthcare choice plus. They covered 80 or 90 %, but we also have a 2500 DME cap. The pump and three month supply of supplies (which are also DME) was around 1700 (we have a 250 deductible).

    Also, keep in mind the pump supplies like resevoirs, insets ect are under that dme cap. So any extra supplies we would need for the rest of the yearwould be out of pocket. With doing our pump start now, we should only have a month or so of supplies that are on our wallet!

    The pump companies told us exactly what we would have to pay for each pump. We gave them our insurance info and they made the calls and let us know the amount for each.

    Animas has been fantastic to work with!!!

    Good luck!
     
  9. khoward1017

    khoward1017 Approved members

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    I have UHC also but it still depends on the plan as to which pump is covered at which rate. Animas was covered at 90% and supplies at 100% but the medtronic was only covered at 70%. And then with the CGMS if we went through a third party supplier our Dexcom would be covered 100% were as if we went through UHC directly they would only cover at 80%. It doesn't make since at all so that best think to do is figure out which 2-3 pumps you would be happy with. Go online complete the forms and let the pump companies do the work. They will tell you exactly what is covered and have all the right contacts. This way you will truly understand your cost for the pump and for the monthly supplies.
     
  10. Daniel's Mom 1993

    Daniel's Mom 1993 Approved members

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    I have UHC and it said out of network - I went ahead and ordered deciding it was worth it but then they denied the pods = paid 80% after $300 deductible on PDM which = $200 and denied the pods - said supplies at other area providers were less - compared them to traditional pump suuplies. I appealed and still denied. But my company is self funded so 2nd level appeals go directly to my co. and they approved.!!! So we get 80/20 coverage after deductible which was $584 for first order and about $70 per month. The only stipulation is I must have Dr write letter once a year saying Omnipod is only tubeless pump available and if in network (Minimed or Animas) becomes available in a tubeless pump we must switch which seems silly but whatever. they mey realize it will be cheaper to continue with Omnipod. It was worth the fight though we love the Pods!:)
     
  11. suzyq63

    suzyq63 Approved members

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    Thank you. Today is phone call day. The first phone call will be to the endo because I suspect the honeymoon is over (it's either that or female hormones acting up for the first time). Without corrections, Alison is staying between 250 and 300 or so. With small corrections (1 unit each time so far since this is a new phenomenon) she still won't go below 200. This is a big change from her usual readings (her last two A1Cs were 6.4 thanks to her strong honeymoon). She woke up Tuesday in the 180s and it's been deteriorating ever since.

    I'm really not exactly sure what I want in a pump, so I think I'll also spend some time searching messages here, where all the real experts are.
     
  12. momandwifeoftype1s

    momandwifeoftype1s Approved members

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    This is a very timely thread for me. My next available time will be spent talking to United Healthcare about coverage for Connor's pump. I know we reached out deductible this year.
     
  13. valerie k

    valerie k Approved members

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    we have a plan with united health care, but Im sure there are hundreds of different plans under that umbrella. Our pump cost us 600.00 becouse they covered 90% becouse we met out out of pocket deductable for the year (matts hospital stay)We ordered the CGM at the same time, had a snaffu, and it cost us the next year price and we had to pay 300.00 for that, or 30%...

    Pump reps are the best, they seem to know which insurence covers thier products and will do all the leg work for you.
     
  14. Lizzy731

    Lizzy731 Approved members

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    I know they have a contract with medtronic but we were able to get the omnipod very easily. Omnipod negotiated a rate with them.
     

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