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Anyone with United Health Care get pump supplies thru pharmacy?

Discussion in 'Parents of Children with Type 1' started by mmgirls, Feb 25, 2011.

  1. mmgirls

    mmgirls Approved members

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    I found a local specialty pharmacy that is willing to look into coverage for me, but thought I would ask here.
     
  2. buggle

    buggle Approved members

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    We're switching to United Heath Care at the beginning of the month. I called them to ask about coverage and according to our local rep and Dexcom, sensors are carried under the pharmacy benefit -- so are pods. So, I assume that pump supplies are too. If you get the procedure code or NDC number from the provider of your supplies and call UHC, they should be able to tell you how/if it's covered.

    ETA: It sounds like some policies have Medco and they should carry pump supplies and sensors. We have Prescription Solutions. But if you call the pump or CGM company directly, they should be able to tell you how your policy covers the supplies.
     
  3. mmgirls

    mmgirls Approved members

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    Yes we have medco, and our policy has always ran them thru DME, but with a hight deductable and now coinsurance. I am exploring if I have an option to DME with deductable and coinsurance rather that pharmacy copays.
     
  4. Nancy in VA

    Nancy in VA Approved members

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    When we switched to UHC, hubby called and the pharmacy people couldn't even find Animas as a product. Ours are DME
     
  5. SusanK

    SusanK New Member

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    We have UnitedHealthcare. Last year our plan changed to a high deductible plan, where we have lower copays if we have pump suppolies and sensors run thru the pharmacy benefit. I still order supplies directly from Medtronic, but tell them to bill the supplies to Caremark. I have found that it works better to call Medtronic to order supplies, rather than ordering online. The customer service people at Medtronic have been helpful when I have ordered supplies. They even helped get our prescription changed so that I could get 2 boxes of supplies per month rather than the standard 1 box.
     
  6. TerpSteph

    TerpSteph Approved members

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    This is the case with us too, though our son uses a Minimed pump. Pump supplies, CGMS and test strips are all covered under the DME benefit. We have a separate prescription plan that covers insulin.
     
  7. Gracie'sMom

    Gracie'sMom Approved members

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    We have UHC. Pump supplies we order thru Animas directly, but CGM is considered pharmacy and no commercial pharmacies carries them, we have to go thru Edgepark due to an agreement between our particular UHC plan and Edgepark.
     
  8. Nancy in VA

    Nancy in VA Approved members

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    Gracie's Mom - we get our CGMS supplies from Edgepark too, but still DME. I used to get Blood Ketone strips too and UHC won't let us get them through Edgepark b/c we have to get them through MedCo as pharmacy, instead of DME.
     
  9. mmgirls

    mmgirls Approved members

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    Edgepark as Pharmacy or DME???

    I order now thru edgepark as DME
     
  10. sahmcolorado

    sahmcolorado Approved members

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    Are you getting some insurance coverage for CGMS supplies for your 5 yr old? I thought that CGMS was not covered for under 18? We REALLY want to get CGMS for our daughter, but can't afford the sensors each month.
     
  11. Nancy in VA

    Nancy in VA Approved members

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    We had 100% coverage since we got it 2 years ago.

    Initially it was from CIGNA and now UHC. We have hypounawareness - even now with the CGMS - and still can show significant lows even with the CGMS. We catch more but they aren't gone. Haven't had a problem getting coverage
     
  12. sahmcolorado

    sahmcolorado Approved members

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    So if a medical need is shown, even if it is not FDA approved, insurance will cover it? I'm really surprised by that. I'm so glad you get the coverage for it!!
     
  13. buggle

    buggle Approved members

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    Do you go to the Barbara Davis Center? If so, they have a person who's job it is to order pumps and CGMs. All you need to do is get the ok from your endo and they will do all the paperwork and deal with your insurance company.

    My son started CGM at 8, but other kids start much younger. As long as you can show medical necessity, kids can use them.
     
  14. sahmcolorado

    sahmcolorado Approved members

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    We haven't been to Barbara Davis yet. DD was dx 3 months ago and we have our first ped endo appt in a couple weeks. He is not at Barbara Davis, but maybe we can still figure out how to get them to help us.

    Do you go to BD? We got such strange information about it - could never really understand what it meant to "go there". Seemed like it was the same as meeting with our CDE and seeing an endo and they said that if we went there, we couldn't meet with our local CDE anymore. We didn't want to have to always drive an hour each way for education so we stuck with our pediatrician and local CDE to start out.
     

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