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A+ Medical Question

Discussion in 'Parents of Children with Type 1' started by Tena, Mar 31, 2009.

  1. Tena

    Tena Approved members

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    We have been using A+ since Aug 08. Believe me, I am very thankful for the money we have saved. But here is my question:

    A+ bills to the durable Medical side of our insurance. I just got an update on our policy (bcbs of ok) and it says we have a $5000 maximum on durable medical. Well I just got an EOB (from OCT08) and A+ billed insurance 2500.00 on durable medical but only got 1400.00 (cant remember the exact amt). So basically DM will be maxed out in 4 months. What will A+ do then? Will they drop us? And then how will that affect me with our insurance? I know Em's pump was paid out of DM so if that is so and we max out by 4 months, eventually we could be in trouble.

    Anyone have any knowledge regarding this? I am now wondering if we shd go back to regular pharm and paying co-pays. In a way I feel like I am letting A+ milk my insurance co. too. Any thoughts? :confused:
     
  2. Mama2H

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    My understanding is, if they have a durable medical cap you are not going to be able to use them an entire year :( Call Micheal at A+, he will be able to tell you exactly what will happen.
     
  3. Flutterby

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    that 2500 was probably more than one month worth of supplies.. I got a statement from the insurance for 2300 from Aplus.. they only got about 900 of it or so.. I couldn't for the life of me figure out what the heck costs 2300 that we get from aplus.. we don't get sensors through them, and pump supplies aren't that much.. so I called aplus to figure out what the heck they were billing.. she said it was several months of supplies all billed into one flat payment.. not one product and not one month.. so you may get more than the 4months or whatever it is you think you'll get out.. also, you do NOT have to get everything through them every month.. things like alcohol wipes, ivprep, tapes.. etc, you can go with every other month or so.. you can call them every month and let them know what you want so you aren't getting things you don't need right then and aren't taking up money from the cap..
     
  4. Tena

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    this is exactly what I do. I don't get everything every month just what we need. However, will this cause us headache down the road. I know DM is what pays for medical devices ( pumps, crutches, wheelchairs, etc) not that we would ever need them but what if we do, then we would be stuck. I don't know. I am having serious misgivings at this point.

    On one side, I really have appreciated the break from the RX copays. But if it causes more trouble down the road. What about when her pump is needing to be replaced? What do you do then?

    Tena
     
  5. jcanolson

    jcanolson Approved members

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    Is the DME a lifetime cap or a yearly cap? If it is yearly, you could just not use A+ during the year that you will be replacing the pump.
     
  6. Flutterby

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    we don't have a cap so I don't know what others in that situation do..
     
  7. wvchinacat

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    We are one of those fortunate to have no cap and a really low deductible. but when we got started those were the first questions I asked and had we had a cap - we would have probably gone back to rx. We will be getting insulin in the warmer months from rx rather than A+.

    I also recently heard many say that BCBS is now out of network. Well I called and found out that yes our policy is out of network - but we have a low out of network deductivble and they said they will NOT bill me for the deductible . . .so hopefully they stand by this . . . bc then we would have to come up with about 1000. (for both DH and DD)

    Also I noticed that on our EOB it is not listed as A+ and there is no differentiation in what is billed - it is all called "medical supplies" It is really hard to tell what is actually being billed. IDK:confused:
     
  8. redmcgee

    redmcgee Approved members

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    I looked at our EOB and could not tell what was going on. It is all listed as medical supplies and some out of network???? Not sure what is going on.
     
  9. Tena

    Tena Approved members

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    I am really thinking about going back with reg rx. maybe doing mail order. I know that bcbs does not cover one touch strips anymore through rx but A+ is still giving them to us by DME. So I am getting wary.. I think I will call tomorrow. and see what they say. I am almost afraid to call bcbs. but I will see what A+ says first. I figured it today.

    For 3month mail order: insulin 100.00 strips 100.00 pump supplies 50.00 and hubby's meds 50.00 So 300.00 every three months in copays. a little more when lancets, iv prep, precision ketone, and glucagon needed. but we don't need these every month.

    So $1200.00 per year in copays maybe $2000.00 at the most vs. being out the $5000 DME. I realize that doing the DME w/ A+ I am not paying anything but probably will in the long run.

    Am I thinking this correctly, or am I off my rocker? LOL. You know, lack of sleep causes me to do crazy things and makes me worry about stupid stuff alot too.
     
  10. Sam's mom

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    I have a $3000 DME cap per year on my insurance policy (have had this cap since 12/07) and I have used APlus since then and have had no problems whatsoever. I was worried about the cap and was told that they could bill through the pharmacy side of their business. We get all pump supplies, test strips, etc., basically everything except insulin through Aplus. Good luck!
     

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