- advertisement -

Tricare and insulin pumps

Discussion in 'Parents of Children with Type 1' started by Mish, May 20, 2014.

  1. Mish

    Mish Approved members

    Joined:
    Aug 20, 2009
    Messages:
    1,393
    Just encountered a new situation that I've never heard of before, from anyone. Warranty was up on my son's pump and I had medtronic submit the approval to Tricare for the pump. We have Tricare Reserve, and I knew it was going to be covered at 80% but we're close to our cap for the year, so I figured maybe $100, OOP in total and then done.

    But, nope. Not so easy.

    This is the email I got from MM the other day.

    At first I thought it was some scammy MM thing, but after I called Tricare, it's not. It's the way Tricare is saying they are covering all large durable medical items. The girl at Tricare actually had the balls to tell me that it was because if they paid for expensive medical items all at once, they'd be out of business. :confused:

    Medtronic tells me that Tricare and Medicare are the only ones doing this, and it's a royal pain the butt. She can't even tell me who will be billing me.

    My big issue with all of this is that it's a covered benefit item for which I'm responsible for 20%. Fine. Except that for this year I'm currently at my limit OOP for the year and and my policy says that when I hit my cap, everything is covered 100%. But, nope. Somehow they're going to stretch this out past October (13 months) and so then it rolls into our new policy year, and then I have to start paying for it all over again.

    So, this is really just a vent and a warning for anyone contemplating getting a new pump with a Tricare version other than Prime.
     
  2. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I find this completely strange!
     
  3. misscaitp

    misscaitp Approved members

    Joined:
    Jul 26, 2007
    Messages:
    1,121
    Thanks for this, it actually explains a lot with the co-pays I've been getting. I know when you have Tricare Prime - Active Duty (North) they pay the full cost upfront, at least that is what they did with my Minimed and Omnipod. My dad is now recently retired, but I just ordered the T:Slim last month and I was charged a 20% copay for the supplies, not the actual pump, but then had a random $66 a month later.
     
  4. Michelle'sMom

    Michelle'sMom Approved members

    Joined:
    Aug 21, 2009
    Messages:
    1,432
    Tricare & Medicare are not the only ones doing this. Our insurance changed to a self funded plan on May 1. Pump coverage is exactly what's described above.
     
    Last edited: May 21, 2014

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