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UHC, has anyone else seen this???

Discussion in 'Parents of Children with Type 1' started by msschiel, May 3, 2016.

  1. msschiel

    msschiel Approved members

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    UHCpump.jpg

    This is wrong on so many levels. They force us to use certain test strips (which thankfully are the ones that we are planning on using anyways), but now they will be forcing us which pump to use??? Medtronic wasn't even on our list when we were choosing a pump. It was between t:slim and Ping, and we went with the t:slim. We don't pay anything OOP for our supplies (except for dexcom), but this is ridiculous! Thankfully we have only been on our pump since November, so hopefully this can be fought and something can be done and coverage for all pumps will be reinstated.\


    EDITED: After rereading, it does say anyone under 18 won't be forced to use it, but still.
     
    Last edited: May 3, 2016
  2. Lakeman

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    I cant't say for sure how your insurance company works but with mine a preferred product is the one they want you to use and they make it easier to use that one but don't disallow others. I do see in the letter that the change won't effect you until your pump is both out of warranty and broken. I agree that it is wrong on many levels. However the other side of the coin is that they are the ones paying for most everything so clearly they should get some say. Your choice is to use another insurance company or to pay on your own since no one forced you to have a contract with them - oh wait someone did force you to have a contract with them. Maybe some of the blame should go toward those who took away your freedom to choose.
     
  3. msschiel

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    Thankfully by the time this pump is up, he will still be under 18 (unless they change things by then). We had a decent BCBS plan before having to switch to UHC 2 years ago. Have had nothing but problems with UHC since then! Have to fight tooth and nail just to get enough test strips (although not using quite as many since getting dex). They just gave me 200 last week, so I will have to call and have to fight to get another 100 to last us the amount of time they will only pay so often for.
     
  4. Nancy in VA

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    When we first wanted the t:slim, UHC didn't have an in network provider and we had to wait 6-9 months before they did.
    Their out of network policy benefits are awful - I looked into them when we could find the pump in network. The premiums are higher and the deductibles are higher all for the privilege of paying more out of pocket before coverage kicks in for something out of network.

    This just sucks! No way should something this important be dictated to a patient. I'm guessing that Endos will start writing letters of medical necessity to try and override the policy. Since we probably have at least 2-3 years on the t:slim, I can only hope this policy will be overturned by then.
     
  5. msschiel

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    Our only option was Byram for the pump. Was a total pain in the butt to get the pump, it took 3 months because they couldn't fill the paper work out. This insurance is the worst that we have ever had. We had no trouble getting the dex, called on a Monday and had it by Friday.
     
  6. Megnyc

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    I saw it on facebook. I guess I have a different view on it. I don't use a medtronic pump currently but I have in the past. If this is a way to reduce the cost of insulin pumps (especially with more and more people with type 2 using insulin and using pumps) then great. Choice is a good thing but if we want everyone with diabetes on insulin to be on a pump then we need to reduce the cost. All pumps available in the US perform the same basic task- pump insulin. I can't really buy the argument that it is medically necessary for an individual to use one pump over the other. That is excluding omnipod for athletes and maybe the ping for a very young child (but medtronic's next pump will have a remote).

    In my opinion, health insurance companies should pay for pumps because there is evidence that they lead to improved outcomes. However, I have no issue with them dictating a specific pump. I have a bigger issue with being forced to use specific test strips because there is an accuracy difference there.

    ETA: For the record, I have United healthcare and have about 2 years left in the warranty for my tslim and I will continue to have United healthcare for the foreseeable future so this policy does apply to me.
     
  7. Just Jen

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    BINGO! Once you start mandating anything, other mandates will follow. Soon, you have universal single payer healthcare where you have no choice, no options, few doctors and long wait times.
     
  8. Christopher

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    I assume you are insinuating that the ACA is what forced her to have a contract with that particular insurance company. But is that true? Did they force her to contract with that particular insurance company above all others?
     
  9. Christopher

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    What I bolded above is a huge assumption on your part. Why do "we" care what method people use to deliver insulin? I sure don't. To me that is an incredibly individual choice and should only be decided on by the INDIVIDUAL.

    Yes, all pumps perform the same basic tasks, but there is a very big difference between tubed pumps and tubeless ones. And using your logic, all tests strips perform the same task too. Sure some might be fractionally more accurate, but you are still getting a blood sugar reading.
     
  10. Snowflake

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    Actually, this kind of describes my HMO! :)

    Joking (and politics) aside, I feel pretty lucky that, despite the arbitrary bureaucratic hassles of dealing with my insurance company, my daughter access to such amazing technology that was barely available just a decade ago.
     
  11. Megnyc

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    I meant that presumably most people want everyone to have the choice to use a pump or not. I don't care how anyone chooses to deliver insulin. I just think everyone should have the opportunity to use a pump, in particular people with type 2 who currently have more issues getting insurance coverage for pumps.

    Having used both a tubed pump and a tubeless pump I personally don't find a major difference. However there is a huge cost difference over 4 years. People can disagree with me but I believe insurance companies can choose to say that the excessive cost of the pods is not worth it. I believe most kaiser plans don't cover omnipod and their patients have managed to make a tubed pump work.
     
  12. Beach bum

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    Ironically, we have had to fight every year to get Bayer Next strips covered by UHC. The strips that go in the meter that talk to the MM pump. I wonder if we will have to do battle anymore? We've got 3 years on one pump and two on the other. Who knows if we will still have that insurance then...
     
  13. Lakeman

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    I was insinuating that congress created laws that make it very difficult to get insurance anyway except through ones employer and the employer gets to choose the company. The vast majority of people in the US will be pushed into taking the particular plan their employer picks for them. Until the ACA came out one did have a choice to choose the employer plan or go any of several other ways (usually all of them worse). Now those alternatives are even more difficult to stomach. No, no one is 100% forced to choose a particular plan but the amount of coercion exerted upon a person to take a particular plan can be pretty compelling.
     
  14. Beach bum

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    Does anyone know if it's a tiered system? Meaning 100% for MM, then a much lower percentage for others? When we started the pump journey 10 years ago, this was the case. Animas was the preferred supplier for that insurance, then a small percentage for coverage of others.

    This new policy doesn't surprise me at all. They've already dictated what insulin we have to use, only cover supplies via mail order, so the pump seems natural. It sucks for the 18+ group, but I hope people are given options i.e. You can choose, but if you choose what we don't like, we won't cover it as well as the one we do like...
     
  15. Nancy in VA

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    We don't even get 100% cover for our non-Medtronic pump now. Our DME coverage is 90% after $1500 family deductible. I would be fine with a tiered system, having ability to choose pump and pay different percentage based on tier, but not complete restriction of opportunity.
     
  16. Megnyc

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    Yeah, I have United Healthcare and have 90% DME coverage after a $200 deductible. We also were just switched from individual out of pocket maxes (of $1500) to a family out of pocket max of $5000 so since I am the only one in my family with any significant medical costs it is going to be a lot pricier for me.

    I would be very much in favor of a tiered system where people pay say 10%-40% of the pump cost based on the cost to the insurer. That hopefully might bring costs down while still giving people choices.
     
  17. sparty87

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    One of the problem with our third party payer system is the divergent goals between the patient and the insurance carrier. The patient wants to make personal/individual choices and the insurance carrier want to minimize expenses while processing claims in good faith. Theoretically, patients can purchase insurance from the carrier that process claims to their liking, but we know that in the real world, you’ll pick whatever your HR chooses for you.
     
  18. Brhodes

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  19. msschiel

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    We just started with the Dex, and that is the only thing we pay OOP for. Right now we are paying 90% until we reach our OOP maximum (which I believe is around $2000). We never meet our maxes because of medicaid as secondary insurance. Once we reach that OOP max, then they will cover 100%. However, dh just told me tonight that we will be switching over to Aetna, so here we go again! Hoping the coverage is similar for the dexcom. Yes, UHC would prefer us to use mail order, but since we have medicaid, we are still able to get our scripts at Walmart.

    Just not looking forward to having to switch insurance for the second time since diagnosis.
     
  20. sarahspins

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    I have UHC and I am not forced into mail order... there's no financial incentive for me to do it and they have never filled anything correctly (and I have enough problems with walgreens on that front - like they keep trying to give me pens instead of vials for my insulin, which I refuse, since it's a higher co-pay) so I choose not to deal with it. If I have an RX problem I prefer to be able to deal with it in person.

    Since they've said they'll continue to cover supplies for an in warranty pump, I am personally not that concerned about it. I practically pay out of pocket when I get a new pump anyways with my $3000 deductible, so I'll just pony up a bit more and get whatever I want. Problem solved. I can only really see this being a big problem for someone with a smaller deductible who just isn't willing to pay out of pocket for a new pump.

    That said, truthfully I could care less what pump I use.... they all do basically the same thing, but I do hate having someone else tell me what I can or can't use. IF they suddenly decided to stop covering dexcom, then I'll be up in arms ;)
     

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