- advertisement -

Those on Tricare...

Discussion in 'Parents of Children with Type 1' started by Mom2Deacon, Apr 1, 2008.

  1. Mom2Deacon

    Mom2Deacon Approved members

    Joined:
    Jul 28, 2007
    Messages:
    2,971
    Did Tricare pay 100% for the actual pump? The person I spoke to today said they would only pay 80% of it because it falls under DME for them. I really think that this man was wrong though.

    Also has anyone gotten insulin from Express-scripts without any problems? Last question, does anyone know if Tricare pays for two kinds of strips? The school nurse was wondering this because she has a difficulty with using the Flash strips. She actually prefers accu-chek. She understands if I cannot do anything about it though.

    --Sara
     
    Last edited: Apr 1, 2008
  2. KeltonsMom

    KeltonsMom Approved members

    Joined:
    Sep 12, 2007
    Messages:
    3,605
    Not sure how much Tricare pays for the actual pump.

    I do use Express Scripts for the insulin and it comes in a nice Styrofoam cooler with ice packs, the insulin was cold when it came via UPS.
     
  3. Lindy

    Lindy Approved members

    Joined:
    Apr 1, 2007
    Messages:
    966
    We had a horrible time with Express Scripts - and now go thru Liberty! SO MUCH BETTER!!! I highly recommend Liberty. We get our insulin locally now - and all supplies thru Liberty

    Express Scripts made errors on ALL of our Rx's - you cannot speak with anyone who can actually see your Rx's - so you end up having a pointless conversation with a CSR... Our insulin was shipped to the correct city, however delivered several blocks away from our home. A kind elderly gentleman delivered our box of insulin to us... that was the last time we used Express Scripts.

    We have the Omnipod Pump - it was covered and is covered 100%.
     
    Last edited: Apr 1, 2008
  4. frizzyrazzy

    frizzyrazzy Approved members

    Joined:
    Dec 23, 2006
    Messages:
    14,141
    our Tricare prime paid 100% for the pump and yes, it was covered under dme. If you've got tricare prime it should pay 100% on dme. :)

    It may pay less if you've got any other kind of tricare plan though. :)
     
  5. Riley'sMom

    Riley'sMom Approved members

    Joined:
    Jun 23, 2006
    Messages:
    604
    we have the MM and tricare prime, they pay 100%.

    we also get all of our supplies through liberty, except insulin, which we get at CVS. (we don't live near a military base)

    as for the strips, i think you will have trouble getting 2 different kinds. when we first tried to fill the ketone strips they refused cause they thought they were regular test strips.

    i think you should stick with one type of test strips and the nurse should deal with it. i don't really understand the having trouble with it part? it would kind of scare me if she can't even get that right, how does she do everything else? also, some test strips run higher/lower than others, so you might want to stick with the same type meter for consistency?

    hope that helps,
    jessica
     
  6. KeltonsMom

    KeltonsMom Approved members

    Joined:
    Sep 12, 2007
    Messages:
    3,605
    This thread got me wondering about something..When Kelton was on the pump Tricare Prime would only pay 80% of anything DME related. I called the local TriCare office on Base and asked them why..

    Here is what I found out, my husband is retired Navy, and Tricare will pay 100% for active duty only, well TriWest that is, but TriSouth and other regions pay 100% for both retired and active duty..Same insurance, so why do they not cover the same?
     
  7. Mom2Deacon

    Mom2Deacon Approved members

    Joined:
    Jul 28, 2007
    Messages:
    2,971
    We are on tricare north..health net..is that why they may only pay 80% because of the region we are in? We are prime though.

    --Sara
     
  8. frizzyrazzy

    frizzyrazzy Approved members

    Joined:
    Dec 23, 2006
    Messages:
    14,141
    All prime should pay the same regardless of region but I do believe that retired/active will pay different and then active/national guard pays different too.
     
  9. Mom2Deacon

    Mom2Deacon Approved members

    Joined:
    Jul 28, 2007
    Messages:
    2,971
    She was having problems in the beginning with the new strips. You fill them from the side not the front, and they soak the blood differently too. She isn't having problems with the strips now but her substitute did. She was wondering if I could send something else in because of subs. I should have explained better.

    Frankly, I love our nurse. She is great and will test Deacon early if I call and say he needs to be tested. She said for me to call or drop in anytime. I am very involved with Deacon's care at his school. I let her know of our changes and what to expect because of those changes too. She is very understanding. She is also the nurse for my older sons' school in the afternoon.

    --Sara
     
  10. KeltonsMom

    KeltonsMom Approved members

    Joined:
    Sep 12, 2007
    Messages:
    3,605
    I get other DME supplies not related to D and Tricare pays 80% of these supplies too..I had to back off of getting more supplies because of cost..
     
  11. Riley'sMom

    Riley'sMom Approved members

    Joined:
    Jun 23, 2006
    Messages:
    604
    before we moved here we were in tricare north/health net and they paid 100% for everything. if you have tricare prime/active duty they will pay 100% no matter what region.

    like fizzyrazzy said, the only different would be active or retired.
     
  12. Twinklet

    Twinklet Approved members

    Joined:
    Jun 29, 2006
    Messages:
    2,123
    We have TriWest Prime, active duty, and they paid 100% for the pump and pay 100% for all pump supplies.

    We get strips through our local pharmacy and pay $9 for 300 per month. We used One Touch at first, then switched to Freestyle after Emily got her pump. No problem switching, but I think they'll only cover 1 brand at a time.
     
  13. Vi'sMom

    Vi'sMom Approved members

    Joined:
    Feb 18, 2008
    Messages:
    71
    We are Tricare Prime Remote.

    Tricare paid the majority of our pump we paid $400 which was the remainder of our yearly co-pay cap. I guess if i waited a few more months they would of paid 100%.
     
  14. roo'smom

    roo'smom Approved members

    Joined:
    Jan 5, 2008
    Messages:
    258
    We are tricare prime, in the north region (since when is Virginia "north"?) and tricare paid 100% for our pump, as well as our supplies (which we get through Liberty - like them much better than express scripts, plus no copay w/ Liberty). We were getting two types of strips for awhile - different meter in school than home. We just asked them to split the prescription by percentages - 80% one type and 20% the other. Never had any problems with it.
     
  15. Illinifan

    Illinifan Approved members

    Joined:
    Feb 15, 2007
    Messages:
    1,405
    We are still doing MDI, so I have no first hand knowledge of what would be covered for a pump or pump supplies, but I do know that I would insist on them covering 100% based on what I read here.

    I can't remember if I'm the only retired military guy on this board, but I pay our Tricare Prime premium every quarter and other than the priority in which we are seen at the MTF, my Tricare Prime benefits are the same for the family as they would be if I was still active duty.

    There are some differences for the service member once you hit retirement age, but dependent coverage is the same.

    BTW...yesterday was my 3rd anniversary of my AF retirement. Time flies when you have a Type 1 kid! ;)
     
  16. Mom2Madi

    Mom2Madi Guest

    We are Tri-Care South, active duty. Pump was covered 100%. I get my supplies through Animas for the pump - also covered 100%.

    I just started with Express Scripts this month for strips and pay $9.00 copay for those. I was going to suggest the same thing the other Mom said - ask them if you can spit up the percentage of strips. I would think if you have a prescription for both they shouldn't care what they cover as long as you don't go over the total number per month alloted to you.

    As for as insulin I have been filling it at the base but once my current prescription runs out (I was seeing an endo on base before) I have to get my civilian provider to write me a script. I know on our base there is one pharmacy location that will fill off base scripts so I'm going to try that before trying to get Express Scripts to fill it.
     
  17. momofphoenix

    momofphoenix Approved members

    Joined:
    Jul 14, 2007
    Messages:
    852


    I used to use Express Scripts and never had any problems with my DS insulin.
    As for the 2 different test strips, Tri-Care will only pay for them (if they carry them at the base Pharmacy so you dont pay copays) if it is NEEDED... a note from the Endo saying that you need 2 different meters and test strips, but remember Tricare wont pay for the meters, that is out of pocket
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice