- advertisement -

Insurance help in MAINE - AETNA

Discussion in 'Parents of Children with Type 1' started by joy orz, Mar 13, 2014.

  1. joy orz

    joy orz Approved members

    Joined:
    Feb 7, 2008
    Messages:
    2,460
    Hi there.

    I haven't been on in quite some time, but I am hoping someone in Maine with Aetna might be able to help me out. My husband just got a new job and our insurance changed to Aetna.

    Her strips, lancets, and insulin are covered as preventative, but her pump supplies go under durable medical, and we have a $4000 deductable!!! Then they will only pay 80% so essentially, we are expected to pay 10,000 in out of pocket medical expenses for her pump supplies! ARE YA KIDDING ME?

    When we chose this plan and they said "diabetes supplies are covered" we ya know assumed that meant diabetes supplies are covered. Help?

    Does anyone else have an Aetna Choice POS II plan? Is there any work around? They will pay for needles but not infusion sets. Why on earth is a syringe covered, but not an infusion set?

    Anyone?

    Also, if anyone has and insane deductible plan, how do you budget for it? Thanks!
     
  2. GChick

    GChick Approved members

    Joined:
    Nov 9, 2013
    Messages:
    213
    Not even sure why I'm posting as I don't believe I will be of any help. But while I am not even a US citizen nor do I live in the US my insurance plan in my country has a link to Aetna in the US which is how I got my pump (All pump supplies still get shipped only within the US though... which causes some problems, but are work-around-able).

    My plan has a total of $500 deductible and they cover 80% of both the pump and supplies.

    I'm sure things vary from one Aetna plan to the other... but hopefully there might be more wiggle room somehow, if someone in my situation can be covered as much as I am through Aetna.

    Good luck. Hopefully someone with a different Aetna plan will chime in.
     
  3. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I would also check on the deductible for DME, I have had some plans that the deductible was not towards DME, and is there a Max OOP for the individual?
     
  4. redheadmom

    redheadmom Approved members

    Joined:
    Mar 26, 2010
    Messages:
    104
    I have Blue Cross. I had a similar situation where my pump supplies (Omnipod) were covered under durable medical (at 80%) and the deductible had to be paid first. Then I just found out from reading posts on this forum that the supplies are actually also covered under the pharmacy side of my coverage. So I called the mail order pharmacy that my policy uses (which is Express Scripts), I asked them to look up Omnipod to see if it was a covered "drug", and they said yes. So my doctor called in a RX to them, and I just had to pay a prescription copay for the supplies instead of the deductible and 20% charge. But nobody at the insurance told me this...I had to find it out from you guys on the forum! So maybe it's worth calling whoever Aetna uses for mail order pharmacy and seeing if they have your supplies listed as a covered "drug". I have no idea why my Omnipod supplies are listed as a "drug", but I am happy they are! Even if your specific pump supplies aren't listed, maybe another compatible brand might be?
     
  5. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    All you need is the NDC # from the items that you want to check on.
     
  6. Lee

    Lee Approved members

    Joined:
    Oct 5, 2006
    Messages:
    9,633
    I am having the opposite problem right now! They want me to pay insane amounts for insulin! Try here -http://www.ezdsi.com/ - they are in Bath and I get all of Coco's supplies, except insulin and test strips, from there.
     
  7. joy orz

    joy orz Approved members

    Joined:
    Feb 7, 2008
    Messages:
    2,460
    Alas and alack, I have called all the people and offered to get our supplies from anywhere... It is not covered. Ugg. Thanks for all the suggestions, looks like we are just going to have to suck it up on that account. pfft.
     

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