Open enrollment is upon us and I will likely upgrade my coverage. (I've always had the lower level plan because I never used the benefit -- now I'm needing "better" coverage because I was diagnosed T1 in October after two years of operating as a T2.) I'd like to know if anyone on this board knows the finer points of (what I affectionately call) United NoCare's tiers, enough to help me make an informed decision. For example, my current plan won't allow a local pharmacy to dispense more than 30 days' oral meds, insulin or strips. If I go through the carrier's dispensary the maximum number of strips they'll dispense for 90 days is 600, despite a script that calls for testing 8-10 times per day.
And I don't know whether they'll cover a pump and monitor. I would seriously doubt it -- after all, this carrier denied paying for diabetes education classes when I was first diagnosed T2.
With thanks in advance, any advice will be greatly appreciated.
I have the UHC Options PPO through my company. They covered 85% (or maybe 80%) of the pump and cgm. The Dexcom CGM sensors cost me $49/4 sensors out of pocket. The MM pump supplies vary based on the infusion sets. I get as many test strips as I want…I take my prescription to Walmart and whenever their computer comes up with “over the limit” or some such nonsense, the pharmacist calls up the insurance company and tells them that I have an override on the order by my endo and gets me my strips. I currently get 500 strips/month.
I have United Healthcare Choice Plus. They will only pay for 300 strips/month irrespective of what my doctor orders(that’s the maximum benefit, no overides.) They did pay 100% of my animas ping pump, because I had already met my deductible the year I got it. But this year I have had to pay cash for the pump supplies until I meet my deductible, then they will pay 100%. My deductible is high, so basically I’ll be paying cash for the supplies unless I have a hospital admission or something to max the deductible.
I have the UHC Choice plan through my employer. My plan does not have a deductible. They covered 100% of the pump and pump supplies. The only thing that isn’t covered are the IV prep wipes. They also covered all my test strips at the lowest copay level and all insulin at the 2nd teir level. Unfortunately for me, my employer switched our perscription benefit to Medco and now all my test strips and insulin are at the 2nd tier, which increased the costs alot for me a month (mostly because of test strips). They have also covered most bloodwork I have done every three months. I am only paying about $20 OOP for bloodwork. I also get regular information on diabetic screenings I need to have done. For example, I need an eye exam, so they sent me a reminder to get one.
I pay a little higher premium, but it is worth it to me not to have to worry about meeting a deductible.