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does insurance pay for pump?

Discussion in 'Parents of Children with Type 1' started by jessicat, Feb 20, 2012.

  1. jessicat

    jessicat Approved members

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    I feel like I have a pretty good medical insurance/prescription plan through my employer. but I just found out that my insurance covers 0% for a pump or the replacement components. Is that common? With so many people using pumps online here, do all of you pay out of pocket? Are there other means/funds available?
     
  2. jbmom1b2g

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    ours pays 50%. We are fighting our insurance rigfh now cause we were quoted wrong. We were told 80/20 last yr but they only payed 50%.
     
  3. MomofSweetOne

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    Our pump and supplies are covered as Durable Medical Equipment and are currently covered at 90% but that will be dropping to 80%.:mad:
     
  4. L101418

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    I was also told the pump would not be covered when I proactively called the insurance co. In the end, the pump company and endo took care of the whole thing and pump and supplies are covered.
     
  5. jkjones37

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    Our insurance covers pumps. I think it is 80/20. But, since we met our catastrophic cap at the beginning of the insurance year at diagnosis, it is covered at 100%. That is one of the main reasons we are looking into it so quickly...so we can get as much of it covered at 100% as we can .
     
  6. mmgirls

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    ASk about Diabetes supplies and DME coverage. "durable medical equipment". allot of insurance companies have seperate coverage for Diabetes related items.

    I would look into the pumps and decide which one you would like and have the pump company contact the insurance company to look into coverage for you, they know the diffferent insurance companies and know whtat to ask about.
     
  7. manda81

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    Ours pays for 100%, we pay nothing for our omnipod or quarterly pod shipments.

    Check your DME coverage, ask about special diabetes related waivers, and talk to the insurance administrator at your work, and let them know what you're looking for. A lot of times they'll keep that in mind the next time they negotiate a new policy (yearly, usually).
     
  8. Caldercup

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    Also, check to see if your state has any programs to assist in the cost of Diabetes supplies -- in Pennsylvania, kids with T1D are covered and we got his pump and all subsequent pump supplies for free. It even covers the co-pays on his doctors visits and prescriptions.

    The childrens hospital that diagnosed him is who told me about the program. They even helped me apply!
     
  9. hawkeyegirl

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    In my experience, the best way to figure this out is to choose a pump and then to let the pump company figure it out. It would be absolutely astonishing to hear of an insurance company in this day and age that did not cover pumps AT ALL.
     
  10. denise3099

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    Ours covers DME at 90%, so I expected to pay like 700 beans. Well it turns out that the "contracted" price is different than the sticker price. Like when you hosp bill is 50K and the ins pays 8K. But if you didn't have ins you'd owe the sticker price of 50K. So the contracted price is lower and part of the pump price is listed as education, so that isn't under dme, and then parts are supplies, etc. End of the day, I owed 400, not 700.

    Pick your pump, and let the pump company sort it out. They are experts at getting their money. ;)
     
  11. valerie-k

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    matt just got a new pump, our out of pocket is 800.00. 1500.00 if we want to keep the old pump as a back up.
     
  12. Rcj176

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    Ours is covered on an 80/20 basis after deductible is met. Good Luck!:)
     
  13. quiltinmom

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    We got help paying for DS's pump through a medical grant. They are also helping with supplies and prescriptions. It would've been VERY hard for us to afford it, even with good insurance! It's something to look into.
     
  14. jilmarie

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    I think it's quite unusual, but it does happen. I'm in my last year of medical school and our student insurance plan doesn't cover pumps or pump supplies. I can't wait to graduate and get back to "regular" employer-based insurance as a resident :rolleyes:

    Our plan is incredibly inexpensive - 1,200 dollars per year. I suppose you get what you pay for, but it's frustrating that I didn't have any other realistic options as a student due to pre-existing condition clauses.
     
  15. bnmom

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    My ex has Anthem through his employer. Anthem wouldn't touch the pump. Well, they officially approved coverage on it...for a $5,000 deductible :rolleyes:

    I have insurance through the state for the boys and it covers everything 100%. There is also a thing here called Bureau for Children with Medical Handicaps and they say they'll cover any costs not otherwise covered (no income limits).

    I'd check with your county and state programs, you never know what might be available. Also always worth a shot to check with manufacturers, some have discount programs.
     
  16. MomofSweetOne

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    How were you able to find out about medical grants for these?
     
  17. wildemoose

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    So interesting how different student health plans are! My student insurance when I was in grad school covered my pump 100% but they didn't allow me to get 3-month prescriptions on anything, which was a pain.
     
  18. mmgirls

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    this is one that I have run across in the past and poste here.
    http://www.uhccf.org/apply.html
     

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