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What is DME for your insurance?

Discussion in 'Parents of Children with Type 1' started by Jensmami, Feb 26, 2013.

  1. Jensmami

    Jensmami Approved members

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    We switched insurance this year because my hubby's company did. They said it was the same coverage as last year and my hubby just signed up :eek: Now I found out that this company counts almost everything to DME. From strips, sensors, transmitters, pumps, lancets, pump supplies and we have a yearly $5,000 limit.

    We are screwed big time!!! Is there any way we can do something about it?
     
  2. mmgirls

    mmgirls Approved members

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    I would see whether the is a "Diabetes limit", all the DME coverages we have had had a limit but diabetes items were exempt from the yearly and lifetime limits.

    our is for pump and cgm supplies only, other stuff is RX.
     
  3. jbmom1b2g

    jbmom1b2g Approved members

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    Our DME is all pump supplies. The test stripes and lancets are covered under rx's
     
  4. Jordansmom

    Jordansmom Approved members

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    I've also seen a diabetes supplies exception. But sometimes people are successful getting some of the items you listed through their pharmacy coverage, when they've had the same problem. I think it takes a helpful pharmacy or diabetes supply company to work out the details. I think Buggle worked out a deal for (at least) sensors through pharmacy. I'm sure it depends on your specific insurance, but you could PM and find out how she managed it.
     
  5. liasmommy2000

    liasmommy2000 Approved members

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    Pumps, Meters, CGM's and sensors, test strips, lancets, infusion sets, cartridges and iv prep are all DME. The only things that are pharmacy are insulin, syringes and glucagon. Ketone strips of any kind aren't covered at all.

    I too have heard of a diabetes exception. Good luck!
     
  6. hawkeyegirl

    hawkeyegirl Approved members

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    Only our pump and sensor supplies are DME. Everything else is billed under pharmacy. I agree that some folks have had success having things like strips and lancets billed under either, so you may want to look into that.

    Sorry you're having this issue. Insurance is a PITA. :(
     
  7. BittysMom

    BittysMom Approved members

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    We have a "diabetes clause" so our supplies are an exception. Not all customer service reps at our insurance company knew this, so I would double and triple check what you're being told. Hope it works out.
     
  8. denise3099

    denise3099 Approved members

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    We also have a separate prescription ins so we get losts of stuff mail order.
     
  9. MyHandsAreFulll

    MyHandsAreFulll Approved members

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    All of our pump/cgm supplies are DME. Test strips can be either pharm or DME for us.
     

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