- advertisement -

Pump decisions and Insurance questions

Discussion in 'Parents of Children with Type 1' started by rachabetic, May 30, 2017.

  1. rachabetic

    rachabetic Approved members

    Joined:
    Mar 18, 2008
    Messages:
    577
    Hi everyone,
    I haven't been on this website in a while, but I have always been able to trust everyone's knowledge and opinions here.

    My warranty is up on my Tslim and so I am back to the decision making of what to do now. I love my tslim and use the dexcom G4 at the moment as well. I did however recently meet with a Minimed rep for my area to learn about the new 670G system and it seems awesome. I never thought I would ever be considering a minimed pump again and I truly haven't trusted their sensor accuracy since I started on the soft sensors about 7 or 8 years ago and it did not work at all for me. But this new system is intriguing. Everyone who has trialed it, as well as the rep and people he knows who are on it, has said that it is way more accurate than any previous sensor and the same if not better than the current dexcom sensors. Yes, I'm still skeptical, but the reality is, I'm 25 (turn 26 in July, that's another issue) and sometimes, I let life get in the way of my management. Having a system that will catch it when I miscount my carbs when I'm out, or help keep me in a 70-180 range while I'm busy at work or school sounds awesome and beneficial to my health. But I love my Tslim (user ease, touch screen, and small size) as well as Tandem as a company. I am nervous that tandem/dexcom will come out with a similar system soon and I'll be stuck with Medtronic until my warranty is up.

    There is no way to trial the new 670G pump other than letting it go through insurance and then you have 30 days (the rep says he will extend it for me a bit since the new system takes about 2 weeks to truly "get to know you") to change your mind and return it. I would need this trial period as I still do not trust their sensors to be accurate for me. But my issue is, by the time I got the pump to trial it, and went through the 30 day period, it would be well past my birthday (july) and will have turned 26. The dreaded 26...I'll be off of my dad's insurance that will cover the pump and supplies 100% and be on my own insurance that covers the pump 80% and I would be responsible for 20%. I know that's not terrible, but when you talk about a $7,000 pump as well as supplies, it adds up.

    This brings me to my other question. Has anyone gotten a pump paid for through one insurance, and then switched insurance and had the new insurance cover a new pump since they did not pay for any pump, only supplies? Lets say I go for the 670G, and then Tandem/Dexcom come out with the same thing in 2 years, will I be able to get the tandem/dexcom pump from my new insurance?

    Sorry that was long and possibly a bit confusing...but I would really appreciate any opinions on what you would do and opinions you might have on the 670G as well. As well as any insurance switching experiences.

    Thanks in advance for any insight anyone can give me :)
     
  2. obtainedmist

    obtainedmist Approved members

    Joined:
    Aug 3, 2010
    Messages:
    1,538
    I'm fairly sure than any new insurance company would not pay for a new pump without documentation from your DME provider as to the length of time you've had the current pump. They are very careful about paying for ANYTHING they don't have to! I've heard rumors that t-slim will have a hybrid artificial pancreas out by late 2018. They might be more willing to work with you on an upgrade deal even if you aren't out of warranty. You might want to give them a call and see if that would be possible. Still, you'd lose the benefit of those auto corrections for a year if you didn't do the metronic now. You might look into a very low deductible plan so that the co-insurance (hopefully low also) would kick in earlier for your pump. Our daughter has a Cigna plan with a $1300 deductible and a 15% co-insurance on DME once the deductible is met. The monthly premiums are higher, but in the end, the low deductible and low co-insurance make it a savings over a plan with lower monthly premiums.
     
  3. rachabetic

    rachabetic Approved members

    Joined:
    Mar 18, 2008
    Messages:
    577
    I thought the same about insurance covering after less than 4 years. I spoke with someone with the new insurance today and she said they would cover as long as they didn't have it in their record that they paid for it. However, I'm not sure I trust that info. The insurance I'll be switching to is through my work. Their buy-up plan that I'll be doing has a $750 deductible and I am responsible for 20% for DME after I reach that.

    Who is it that you think I should speak to? Tandem?

    I know that tandem is working on new technology all the time. But is it worth it to wait for something that might take years while the technology is with a different company right now? As terrible as I feel leaving such an amazing company, I'm just not sure. It's honestly eating me up inside trying to decide.
     
  4. MomofSweetOne

    MomofSweetOne Approved members

    Joined:
    Aug 28, 2011
    Messages:
    2,743
    If I were you, I'd probably get a new Tandem. You sound so happy with it, and you're not looking at years for the improvements. The cgm integration is due out anytime, the low glucose suspend at the beginning of 2018, and the Type Zero closed loop by the end of 2018. It's already in trials.

    With our and friends' experience with Medtronic, I'd be really leery of trusting that Medtronic would actually let you return their closed loop...and you'll have all kinds of hassles with insurance being involved in that as well. Personally, I'd avoid Medtronic for the reason that they've made exclusive deals with insurance companies to not allow other options. We started out very loyal to Medtronic but they lost us with their bedside monitor that was so ridiculously priced to gouge us parents that couldn't hear the alarms on the cgm. We switched to Dexcom for less than half the price, covered by insurance, for a much superior product and haven't looked back. If they had the customer service experience, the product quality, etc. of other companies, they wouldn't need to be bullying us into having only them as the option.
     
  5. rachabetic

    rachabetic Approved members

    Joined:
    Mar 18, 2008
    Messages:
    577
    Thank you so much for your opinions, I really appreciate it! Where have you gotten all of the info regarding what Tandem has down the road? I know they have usually been pretty honest about what is coming. Do you know if I get the Tslim x2 if they come out with the closed loop scenario, if it'll just be a download? I lost a little bit of trust with Tandem as when I first started, they said that if new pumps became available, I would be able to upgrade. As we know, that was not the case, but I know that was because they were working on the x2 software update scenario.

    I'm really scared to trust Medtronic even though I had their pumps for about 10 years and they seemed to be great. But I have heard some not so great stories since then. I hate that they have made exclusive deals, and honestly, I'm all for the little guy. I just hate to turn down the technology for something that might take forever somewhere else. But if I have some good info that Tandem has it coming down the pipeline, I might be willing to tough out the next year or so.
     
  6. MomofSweetOne

    MomofSweetOne Approved members

    Joined:
    Aug 28, 2011
    Messages:
    2,743
    https://www.tandemdiabetes.com/about-us/pipeline

    There are also other options due out next year if you could get by on your Tandem: BigFoot, iLet. I think the Insulet Horizon is projected for 2019, and I'm not sure about the Type Zero-CellNova date.
     
  7. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    Early on, someone on here told me that you just can't drive yourself crazy trying to figure out what is coming down the pike when you're trying to make a decision on upgrading your pump/sensor. That has turned out to be very sage advice, as I don't know how many times there have been rumors that X is just around the corner, only to have it take five years to get here (or sometimes, never). Here's what I would do. I tell that Medtronic rep that you will try their pump if they can get it into your hands within the next week. You don't say when your birthday is, but even if it's July 1st, that will still give you three weeks with the Medtronic pump. That should give you a good enough idea as to whether it will work well for you. If it does, great. If not, you put in your order for a new t:slim before you go off of your Dad's insurance.

    Jack is due for a new pump any day now. I'm intrigued by the new Medtronic pump, but the fact that there is no "share" capability is a deal-breaker for us at this point. We'll go with t:slim again.

    Good luck, whatever you decide!
     
  8. rachabetic

    rachabetic Approved members

    Joined:
    Mar 18, 2008
    Messages:
    577
    The rep said it would take a while to get it to me. It would have to go through insurance, and then they wouldn't send it to me until everyone on their 630g list gets their upgrade. I have a feeling that's a lot of people. He made it seem as though I wouldn't be getting it for a few months. But that was a couple of weeks ago, so It wouldn't hurt to check back in with him. My birthday is the 13th of July, but I believe the insurance goes through the month. So August 1st, I lose it. But that's where I'm stuck. How do I decide on a pump before I even get to try it? Also, I have tons of tandem supplies, so not having to pay 20% of all supplies would be nice.

    Also, I agree that you can never trust what any company says about what's coming out and when. Just like I have been waiting on that cure that was supposed to be here in 5 years...almost 20 years ago. :rolleyes:
     
  9. rgcainmd

    rgcainmd Approved members

    Joined:
    Feb 6, 2014
    Messages:
    1,374
    We're holding out for the Insulet Horizon.
     
  10. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    Huh. Hadn't heard about this project before. Lots of interesting stuff on, um, the horizon. ;)
     

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