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BCBS of MA-insulin pump coverage

Discussion in 'Parents of Children with Type 1' started by hstroth, Oct 3, 2013.

  1. hstroth

    hstroth New Member

    Joined:
    Oct 3, 2013
    Messages:
    3
    Hi everyone,

    I'm brand new here (been lurking for awhile though) and am looking for information on insurance coverage of pumps. Our son who is 6 was dx'd August 13, 2013 and is doing really well with MDI right now. However, we really would like to transition him to a pump as soon as we can. He asks about it all the time. The issue right now however is I am in process of switching from FT to PT job so we need to go on my husband's health insurance. Our choices are BCBS, Harvard Pilgrim, and Tufts Navigator.

    I talked with Tufts rep today, and learned that they only cover a select list of pumps which doesn't include omnipod or tslim, two options we are considering. We're also thinking about Animas Ping.

    Anyways, I am now trying to learn about BCBS of Massachusetts. From my search online, it looks like they have pretty strict medical necessity criteria for approving a pump, none of which my son meets right now (I don't think)...his BG control is really good right now as I think he is deep into his honeymoon phase.

    So I guess my questions are: does anyone know which pumps BCBS covers, and how hard it is to get one approved if your child is doing really well with their blood sugar control?

    Also, if anyone knows about Tufts and even Harvard Pilgrim with pump coverage, that would be helpful too.

    Sorry if this has been covered in earlier posts... I did search and didn't find anything this specific.

    Thank you!
     
  2. hawkeyegirl

    hawkeyegirl Approved members

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    Nov 15, 2007
    Messages:
    13,157
    It's just going to depend on your particular plan. We have BCBS HMO of Illinois, and they cover all the pumps, but that doesn't tell you anything about what pumps your employer's policy covers.
     
  3. sincity2003

    sincity2003 Approved members

    Joined:
    Jun 1, 2013
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    We have Anthem BCBS in Florida, and I was worried that we didn't meet their strict criteria either, but our OmniPod was approved in 4 days. Your endo will know what to send them no matter what pump you choose to help you get approved. Some insurance companies do have a 6 month wait, I've heard....we are 9 months in and he just got his OmniPod today.
     
  4. Beach bum

    Beach bum Approved members

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    Nov 17, 2005
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    11,315
    We were on BCBS of NY (company was self insured, so it was a very good plan) and we had no problem getting a pump. We went with Animas. At the time (8 years ago) it was 100% coverage, then all supplies were covered under durable medical goods at 80%. We now have Harvard Pilgrim/UHC of MA (again company is self insured) and again, they covered Animas 100% and I think we pay 80% for supplies. We go through their mail order because a)considerable savings b)they are easier to deal with than Animas.

    For both, we had to fill out paperwork, our doctor had to sign off and supply BG readings. We had 0 problem each time. Your doctor can write a letter of medical necessity (they usually have a standard form letter, especially for pumps) that can be included.
     
  5. danismom79

    danismom79 Approved members

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    Apr 21, 2008
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    5,300
    I have BCBS of MA (HMO) and got the Omnipod covered with no problem. Coverage will vary, but under my plan, pumps are covered 100% and supplies go through pharmacy, so there's just a copay.
     
  6. caspi

    caspi Approved members

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    5,134
    Not all BCBS plans are the same. Without knowing the benefits of your specific plan, it's impossible to tell you what is covered. Can your husband get a copy of the different insurance plans offered from HR so that you can call them and ask them? I honestly think that's going to be your best bet.
     
  7. Flutterby

    Flutterby Approved members

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    We have BCBS of MA and have excellent coverage. They've been great with all the supplies, including pumps and sensors.
     
  8. ChristineJ

    ChristineJ Approved members

    Joined:
    Dec 25, 2010
    Messages:
    303
    My son has Tufts and they didn't have the T:slim on their list of covered pumps. I contacted Tandem directly, and they were able to confirm coverage of the T:slim with no issues. Tufts doesn't deal with them directly, though. They do it through a DME supplier.

    Christine
     

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