I literally just got back from a dr.'s appointment where we discussed using a pump. I'm currently on syringes, but want to switch to a pump after 16.5 years. My question is: has anyone dealt with BCBS (I have North Carolina) and how much did you have to pay out-of-pocket for your supplies? Any advice would be fantastic. Thanks!
i have dealt with BCBS of GA & TX. I live in GA but my husbands company is out of TX. How much BCBS will cover all depends on the policy your company has with BCBS. I would get a case manager from BCBS before you go any further. Have BCBS tell you exactly what is covered and how much. I found out by accident that my policy covers all durable medical supplies. This included syringes, meters, testing strips and lancets not just infusion sets, reservoirs etc.
Ask BCBS who you have to order your supplies from. There is a new BCBS rule that you are supposed to order your supplies from an in state supplier. Do not let BCBS make you do their work. Have them find the suppliers.
We just got BCBS of NC and they cover my Medtronic supplies 100%. I second Unicornzzz's advice though, make sure you check with them first!
Good luck!
Nope, they covered it right away!
BCBS NC has an 80% payout for medical supplies, NO DEDUCTIBLE! I've had a pump for 12 yrs, they have been great. They work with Edgepark Surgical for your monthly supplies.
Pumping means you can skip meals, if you feel like it. Only under emergency have I gone back to MDI. Consider a constant glucose monitor also
I do not have a deductible on my durable medical supplies.
May I suggest that you make sure all of the paperwork is completed, approved and on file before you have Medtronic send you anything. If you have to talk to either BCBS or Medtronic make sure to take notes. Keep track of who you talked to, when you talked to them and what you talked about. You may need it in the end. I found out the hard way that BCBS has the right to deny coverage if they see fit. It took me a year to get them to pay for a My Sentry Device even though it was supposed to be covered and they approved it for me.
May I also state that it was not Medtronics fault. They were awesome. They were willing to bend over backwards to help me with anything I needed.
A pump is considered a durable medical supply so if it is more than your deductible all you will have to do is pay your deductible for the pump.
You will want doctor to write a letter of necessity for your pump and the CGM at the same time. They need to include that the CGM is a medical necessity for you and why. If BCBS denies it appeal, appeal and appeal some more until you get what you want. Do not take no for an answer. I got BCBS to pay for the My Sentry Device because I would not take no for an answer.
BCBS just told me they cancelled they contract with Medtronic for the state of NC. Now Medtronic diabetes supplies are only covered via out of network. Unreal!
I have the highest option Federal BCBS and I have to pay $160 every 3 months for basic pump supplies, and pay $75 for strips for that period and $75 for insulin same period, AFTER I pay my deductible first!!! How do you get your Medtronic supplies at 100%???
BCBS NC is 80% for Diabetic supplies, No deductable!