Advice on replacing out-of-warranty pump (insurance stuff)

My Medtronic pump’s warranty ended at the end of November 2020. I knew I was interested in getting Tandem and Dexcom next, but due to a change in the deductible rules it made more sense for me to purchase these this year. I called Tandem in early January, they collected all my information and said I should hear back within 10 work days. Not having heard back, I called them again today to see where in the process things stand. They explained to me that they have not done anything (requested Rx and documentation from my endo, which should have been the next step, all of which then gets forwarded to the insurance company) because I hadn’t identified any problem with my current pump.

During the initial conversation the question about any problems was asked, but it was not explained that the absence of a problem was a deal-breaker. The truth is my Medtronic pump actually had a crack in it in late October, while still under warranty, and Medtronic duly replaced it. (They do have great customer service, as I have always acknowledged…)

My current insurance covered a new pump when the warranty of my current one last expired, 4 years ago, without any issues. (And same with the other 2 insurers I have had for the whole time I have been using a pump.) I simply don’t understand why Tandem wouldn’t even attempt to proceed with the order. Anyone else who has dealt with that? Advice? Should I ask my endo to send the necessary documents and start things on his end? Is that even possible?

(I don’t believe I should be forced to lie and I also feel very uncomfortable with an out-of-warranty pump and want to resolve this yesterday.)

I have no experience with an issue like this but is it possible you were just dealing with someone at Tandem who is clueless?

This question of identifying a problem with your current pump is unexpected. To me the problem with your current pump is that it is out of warranty. No?

Generally, Tandem would first check your insurance, and it may be insurance said it would not cover even if oow and is still functioning.
Many get past this by noting/reporting sticky buttons, scratched up screen, battery cap loose, or similar type issues.

Do you have employer insurance? Check for documentation regarding pump replacement, or contact your benefits dept.

That’s the thing – they haven’t checked with the insurance company! I had researched the coverage and don’t actually expect there to be an issue. The Tandem rep yesterday kept saying “per policy” in a way that made me think this is a Tandem policy. :frowning:

It is possible, of course, except that I have now talked to two people there. The first one took down all the information, but didn’t do anything further, and the second one confirmed that they are not going to do anything until I report a problem. And kept saying “per policy” which is the real issue – this is not a one-off or based on someone’s individual cluelessness.

And, yes, of course you are right that being out of warranty IS THE PROBLEM!

I am going through exactly the same process right now. I too have an out of warranty Medtronic (expired Oct 2020) and want to switch to Tandem. I waited a while to start the process because I wanted to try Dexcom first to be sure that worked for me and it made sense for me to switch.

Anyway, I decided last week that I wanted to go through with the switch. I had heard that Tandem customer service is not always great, so instead of contacting them directly, I reached out to the CDE at my doctor’s office who put me in touch with the local tandem rep. He called me to explain the process and ask questions about the status of my current pump, etc. I am still waiting to hear back but he sounded confident that it would go through.

Is there someone at your dr’s office who can put you in touch with someone at tandem that they work with regularly? They may be more helpful than a random rep answering the phone…

Its an insurance issue not a Tandem policy. Tandem would sell you a new pump every 6 months if they could. My insurance will only replace a pump every 6 years regardless of warranty, unless there is a pump defect. So when they ask the question about problems you have to indicate some type of defect. The one I use is my pump is cracked.

They have quick reference documents. All these companies do. No DME supplier actually has to submit paperwork and wait to see how it works out. That would be a waste of human resources. Instead they can just look up your location and provider, and it tells them right there what the rules are. I’m sure the policy is something along the lines of “don’t submit an insurance claim until the criteria on the quick reference is met”.

That said, this is actually fairly common. You see people posting on the various diabetic online communities about this, with all manufacturers. It’s not specific to Tandem. I actually thought that was a Medicare policy, but I imagine it sounds good to other insurance companies, too.

Your insurance in particular doesn’t want to pay the a new pump when your current pump is in perfect condition. Thankfully, the bar for what’s wrong with your pump is really LOW. It doesn’t have to be malfunctioning, the problem can be cosmetic. Scratched screen, cracked plastic, paint rubbed off, and normal wear and tear. Even something completely arbitrary that can’t be verified, like the screen is dimmer than I remember, or buttons are difficult to press or are getting unresponsive.

Have you changed insurance since you got your last pump? Even if not, their own policies may have changed since the last time. It’s also possible the person who helped you last time just automatically filled in an excuse for you. It’s easier than baiting you to come up with an excuse.

Nobody is actually going to look at your pump. They don’t collect it or inspect it. It’s just a line on an insurance form the pencil pushers need to check off.

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Thanks, that’s good advice. I just thought of that earlier today – I know there is a local Tandem person but had assumed I won’t need their help until it’s time for training. Will be calling my doctor’s office and the local Tandem rep on Monday. Good luck to you too!

I understand the insurance (company and system as a whole) is the root of the problem, but my frustration is that Tandem wouldn’t even try. I had researched the specifics of our policy and based on that (and prior experience replacing my pump as soon as my previous warranty periods ended) do not expect a rejection of the claim.

Thanks for your thoughts!

I am not concerned whether anyone will be looking at the pump. It might sound silly, but I just truly resent being forced to say something that is not true…

But I am aware of and understand everything you are describing. In fact I had looked up the policy details on replacement of DME in November (when I first started researching what to do) and your message prompted me to look at them again now. What do you know – the RUL suddenly is 5 years! Used to be 4, which also aligned with the warranty. But it seems that made too much sense and was too humane to patients…

Anyway, thanks for your input!

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I think like you suggested it is about insurance approval. 4 years is the magic number in the US (assuming you are in the US). Your medical equipment is required to be under guaranteed for 4 years by federal statute. After 4 years your insurance company will cover new equipment. Having said that here is our little experience. My wife who is a T1D and at the time recently disabled was going to go on Medicare, but just prior to all that had reached her 4 year mark on her pump about 2 months prior and we had requested a new pump at that time. Her private insurance company got wind of her eminent change to Medicare and even though not official (we had to appeal twice for disability which also meant she would receive Medicare) the insurance company dragged their feet for over two months instead of providing coverage we were dutifully paying for every month. We had her old pump but if anything happened to it we would have a problem. Medicare took several months to get a new pump approved so it was a while before we had any real warranty for new equipment.

I guess I’m suggesting to stick with it and sometimes (most of the time) we have to be our own advocate and push for what is legally due us!

Best of luck…

I understand your pain. My pump warranty ran out 12/20/2020 (Medtronics). My insurance (Medicare/Tricare for life (retired military)) Would NOT cover minimed cgm supplies so I switched to tandem & dexcom g6. I’ve been on the control iq system for exactly two weeks. I LOVE it. I sleep better knowing the pump will monitor me and every morning I wake up at 110 reading. So important to start your day like that. I would highly suggest the following:
1- Once tandem has your info, call your physician EVERY day to see if they’ve gotten your info from tandem.
2- call tandem every other day.
3- After a few days of your doctor having the request for prescription, show up at the office and ask to see if they’ve gotten it and if so can you help with it.
4-Once you know your physician has sent in your script, go to #2 and get a status.
5-once tandem gets everything (correctly filled out with all requirements met) they will call and ask what supply place you want to use. It’s your supply place that in turns send your info into insurance so, make sure you develop a relationship with one.
6- Once that happens should be two days for tgem to ship out your pump & 90 day supplies

Mine was turned down for:
A - The physician didn’t note my BG when they took blood for an A1C. I had to go do it all again.
B - Didn’t indicate I checked my BG 6 times a day. Had to correct
C - Did not include my c-peptide. They pulled one from a couple years back and submitted
D - The physician didnt document my training for counting carbs.

After all mistakes were corrected I finally got my pump (I was already on the g6). Big learning curve with the sets & reservoirs but I watched videos and all good. I went on control IQ the first night. A little shaken but the pump as learned me and after a few days it was way better.
Please, don’t give up, that’s what the insurance companies want you to do! Best of luck. Holler if I can help. Bob

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