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No Pump Coverage

Discussion in 'Insurance Issues' started by Julies' Julies, Dec 9, 2013.

  1. Julies' Julies

    Julies' Julies New Member

    Joined:
    Dec 9, 2013
    Messages:
    2
    Hi all,

    My 9-year-old son was diagnosed this summer with both T1D and Celiac disease. We're handling this hefty life change fairly well, but we'd love to get him on a pump with the goal of achieving better BG control. We did a fundraiser and are saving as much as possible toward a pump and have been in contact with several pump manufacturers. However, I'm curious to know if there are any ways to reduce out-of-pocket expenses, both for the pump itself and also for the monthly supplies. We plan to save enough for a pump and 1 year's worth of supplies before purchasing. Currently, we pay out of pocket for his testing equipment and are blessed to receive his insulin free of charge from the manufacturers. His diabetes clinic gave him a bag full of pen needle samples, so as of yet we've not had to purchase those (but will when supplies run low).

    Unfortunately, our current health coverage does not extend to pharmacy care, we do not qualify for state assistance, and the new government plans are not affordable for us right now.
     
  2. Don

    Don Approved members

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    Sep 23, 2010
    Messages:
    126
    Please ignore if you understand already but pumps and pump supplies are not treated as pharmacy. They are treated as DME=Durable Medical Equipment. Just a thought but you might consider saving the money toward getting on a government plan. Paying for a pump and supplies for a year could easily cost more than getting on a plan. Insurance plans typically require you pay a % of DME and different plans have different DME copays, ranging from 10-50%. Just as an example, if a plan had a DME copay of 30%, you would pay 0.3 x $6K pump and 0.30 x $120 x 12 monthly supplies=$2232 instead of $7440. The $7440 - $2232 difference could be enough to pay the health plan premiums. Subsidies may also drop the cost of the premiums. After the first year, you would only be paying for supplies. Just something to consider now or in the future. Best wishes for your son to get on the pump.
     
  3. Julies' Julies

    Julies' Julies New Member

    Joined:
    Dec 9, 2013
    Messages:
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    Thanks so much for your reply. We're looking into the Durable Medical Equipment possibility and are hoping for the best. We'd thought about a new coverage plan, but unfortunately, trying to insure someone with pre-existing diabetes in our area is astronomical, so even though a pump may cost a lot, the insurance alone would run many times higher per month than paying out of pocket for a pump (at least at the time of this post, but we're still researching options). Thank you again for your help!
     
  4. mom24grlz

    mom24grlz Approved members

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    Where are you located? Some states have secondary insurances for children with chronic medical conditions. This is seperate from medicaid. A lot of times if you make to much for medicaid you may still qualify for other program. We don't qualify for medicaid but ashleigh still recieves assistance through our state's chronic medical assistanceprogram. They pay for 100% of her bills relating diabetes or her scoliosis. So pharmacy needs, pump supplies, actual pump, ER visits, lab work, doctor visits, her spinal sugery, if it's related to any of her medical conditions they cover it.
     
  5. obtainedmist

    obtainedmist Approved members

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    Aug 3, 2010
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    After January, NO ONE can charge you more because of a pre-existing! That's the best part of the Affordable Care Act (aka Obamacare). You are not locked into your current coverage plan! I suggest you go to the health care exchange website for your state (or the national website if your state doesn't have it's own) and shop for plans. You will be able to compare easily the coverage for each plan! There are various coverage levels (bronze to platinum)...you might find an affordable plan that will cover the DME. Also, if you add up out of pocket costs and compare those to premiums and pump costs with a percentage covered by insurance, you might actually come out ahead! We are going with a higher premium plan for our daughter, but saving money because of the low deductible and 0% DME cost to us once deductible is met!
     
  6. momof2marchboys

    momof2marchboys Approved members

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    Jan 26, 2012
    Messages:
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    I totally agree with the above - the best part of the this new health care is that no one can be denied coverage and they can't inflate the premiums based on medical conditions. The other part that I found out that will come into play this next year is that the co pays for Rx will go towards your deductibles now too!!
     
  7. tracycramer

    tracycramer Approved members

    Joined:
    May 25, 2014
    Messages:
    15
    Thank you and question

    That is extremely helpful information. It is very concrete and clear. Thank you. I am for the first time having to buy health insurance coverage for myself and my 6 and 8 year old girls, the 8 year having type 1 diabetes. We are low income, but not low enough to get Medicaid or other government subsidized plans. Can you recommend an insurer who is trustworthy, affordable, and will cover a diabetic child? She does not have a pump, and we want to get one. Thank you again, tracy


     

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