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Pump supplies as "durable medical equipment"

Discussion in 'Insurance Issues' started by Jfoxsmom, Sep 19, 2008.

  1. Jfoxsmom

    Jfoxsmom Approved members

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    We just switched insurance companies at the start of September...and the previous insurance company (Great West) and the new one Smith Administrators..state that the inserts and reservoirs are all durable medical equipment...and are only going to pay a fraction of the items costs..mind you they still pay fully .. with the exception of copay .. for the test strips and insulin itself..

    I thought that the pump itself was "durable" but the others since you only use them once and then toss them...were not? Everything I have "googled" shows that durable items were; wheelchairs, liftbeds, scooters, etc...

    Am I wrong?
     
  2. Nancy in VA

    Nancy in VA Approved members

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    Just about every insurance company calls the supplies to use the pump DME.
     
  3. iluvmhp

    iluvmhp Approved members

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    Unfortunately that is what ours is categorized as too. And we have a 2500 cap.
     
  4. AmyMcCracken

    AmyMcCracken Approved members

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    We have a $5000 DME CAP. But I was reading my policy the other day and Diabetes supplies are excluded from the cap. Basically these items are necessary and cannot have a limit placed on them. It might be worth reading the fine print in your policy. I was pleasantly surprised.
     
  5. iluvmhp

    iluvmhp Approved members

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    Unfortunately, ours specificall have a 2500 cap on diabetes supplies. I thought it would be excluded, but it wasnt. Definelty worth looking into though
     
  6. Sam's mom

    Sam's mom Approved members

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    I have a cap on dme too but I get my supplies through Aplus and they told me they can bill through the pharmacy and so far (knock on wood) I have not had any problems having supplies covered.
     
  7. iluvmhp

    iluvmhp Approved members

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    How long have you been using aplus? Have you seen a statement from your insurance co yet?

    Thanks for the info.
     
  8. LadyG1974

    LadyG1974 Approved members

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    We recently switched insurance companies also, this is actually the 3rd insurance company we've had since diagnosis. The old company covered everything except the insulin and strips under the DME provision and they were covered at 100%. No copay. Insulin and strips were covered under RX with a $5 copay.

    The new insurance company covers Diabetic Supplies under their own category, which includes the pump supplies and strips. They are still covered at 100% and no copay. Insulin, however is under the RX and since we use novalog, it's a Tier 3 item and requires the highest copay, $40. These are both HMO's.

    Our original insurance company, a PPO, covered the supplies under RX and had high copays. Her original batch of supplies was going to cost ous over $300 just in copays! We called to find out why, and they used a specific service called Diabetic Sense (a.k.a. Liberty Medical) for all diabetic supplies, except the insulin. Everything was covered with no copay and was delivered to our door automatically every 3 months. Insulin was under the regular RX benefit. You might check with your insurance company and find out if they have a service like this that you can use.
     
  9. Sam's mom

    Sam's mom Approved members

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    I've been using Aplus for about 2 years though this new policy with the DME cap started in 12/07. I have received statements from my insurance company showing me amounts that were not covered and that Aplus could charge me x amount. I freaked out when I saw the amount was something like $1500 and immediately called Aplus. They assured me I would not be billed for any amount. That was in February and I have not been billed for anything. I have had excellent service from Aplus in general. :cwds::)
     
  10. Kalebsmom

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    All of that falls under our DME. Which I am very happy about. I pay the first $250.00 and they pay everything else. No cap. Right now I have to pay for strips and I won't once he gets his pump.

    I am not sure why so many insurance companies look at it like yours does. I do not understand it.
     
  11. *Shannon

    *Shannon Approved members

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    We are in the process of getting a pump (prob Cozmo) as I type. It seems as though our daughter's pump supplies will be DME. Although every time I call Cigna to verify "for real" they send me to pharmacy, who sends me to someone else in medical, who tries to send me to someone else in pharmacy... wash, rinse, repeat.

    I'm going to check out Aplus.
     
  12. Nancy in VA

    Nancy in VA Approved members

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    CIGNA is famous for "passing" back and forth between pharmacy and medical. My solution is to go through the pharmacy phone option, ask for a manager. Explain the situation and ask for him/her to conference in a manager from the DME dept and get them both to agree on the phone at that time what it is and denote it in your file.

    We're with CIGNA HMO and all pump supplies are DME. IF you are with an HMO thorugh CIGNA, you won't be able to use APlus
     
  13. redmcgee

    redmcgee Approved members

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    These insurance companies tick me off:mad:
    I had 3 different people tell me different things (2 of them said that diabetic supplies does not count towards DME, 1 of them said oh yes it does they told you wrong) So I did some research and found this listed under DME
    [FONT=&quot]
    [/FONT][FONT=&quot]Diabetic Supplies / Services - Not Subject to Annual DME Max

    Now that does say that it is not counted right?? So that would be the pump not counted towards DME:confused::confused:

    [/FONT]
     
  14. Nancy in VA

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    I think that they are still DME, just not counted in the total accumulation for the max calculations.
     
  15. Kalebsmom

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    Cigna is awful about having one person telling me one thing and someone else telling me something different.
     
  16. KitKat

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    Blue Cross Blue Shield is also famous for this also. It drives me crazy. We have a $4000.00 deductable and a $4000.00 DME. They say test strips, pump supplies everything but insulin is DME. I hate insurance!!

    Did anyone see the story about United Healthcare over charging!!!!!
     
  17. pieipher

    pieipher New Member

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    I have been on my pump for 6 months now and switched insurance in November of last year due to a job change. Under my new insurance I have a $1500 yearly cap on DME and 1 shipment of my pods (for the OmniPod system) would put me over the cap! I have an appointment with my Endo next Monday to get new Rx's for pens again.... a pump was great while it lasted :(
     

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