Cost of Medtronic Pathways Program, getting back under warranty

I am in a panic. My son is Type 1, had a Medtronic pump, switched to T-slim in 2015, hated the T-slim and wouldn’t use it. So he was using an old Medtronc pump that was by now, of course, out-of-warranty. And I was worried about him being on an out-of-warranty pump.

I stumbled upon Medtronic’s Pathways Program- a program to meant to help those who are out-of-warranty get back on warranty-- with Medtronic, of course.

It was explained thus: If currntly using a competitors pump, and out of warranty on your Medtronic-- but wanting to get back on Medtronic-- turn in the competitor’s warranteed pump, and for 749.00 you’ll be upgraded to the new Medtronic, in our case 630G. We had to get the CGM, but insurance covered that. I was told this on phone call by 3 different Medtronic reps in 3 different conversations.

So we proceeded with the Pathways Program. Got new Medtronic 630G pump, sent competitor’s pump (T-slim) back, and waited for 749.00 bill…

I just got the bill, expecting to pay 749.00… The amount due on this bill is $4,449.00!

Here’s the breakdown:
Product: Rebate/deposit for switch2syst… patient balance due = 1249.00
Product: Pathway Charge… patient balance due = 3200.00
Total Amount Due = $4449.00

Has anyone had experience with Medtronics pathways program? I feel like I am the victim of some bait and switch scheme. Thank you for any input offered.

Are you in a position to be able to return the Medtronic 630G or is this not (practically) feasible in your situation.

(Not asking if Metronic would accept it back. Assuming they would accept it back, would you be able to return it based on your family dynamics.)

[Response below assumes you’re in the USA.] Medtronic actually has several different “pathway” programs. Here is a very brief overview of the options: (For example, I am in one called Priority Access, with which I am getting the newest 670 system for no extra cost, after I purchased the 630 in December of 2016.)

The conditions for each of them are different and what you pay out of pocket depends on several factors, not least of which your current insurance coverage for durable medical equipment (DME, the category under which these devices are coded when a claim is sent to the insurance company). In my experience with Medtronic (have been on their pumps since diagnosis in 2008), they are excellent about communicating with patients’ insurance and doctors and really taking care of all the paperwork and confirming everything. So I would generally feel confident in the numbers they gave you.

That said, do you know what your current insurance coverage for DME is? Maybe you have a very high deductible (>$4500) and so you’re still responsible for this whole amount as a result of the insurance situation over which Medtronic has no control. Maybe you get DME coverage only after obtaining prior authorization – make sure if that is the case, one was filed and recorded. Or maybe the claim to the insurance was coded incorrectly somehow (I have this experience all the time with other procedures and medications I have used) and so wasn’t picked up under the correct coverage category.

If I were you, I would first make sure I investigate (if you don’t already know this) the insurance details from your benefits communications (typically, if you get insurance through an employer, a booklet/emailed PDF of some sort). Then – if what you understand those to be differs from how the insurance picked up the claim – I will call the insurance company and ask on what basis they made a decision different from the coverage you were told you have. If the answer is that they never received a claim (from Medtronic) or that there was an error in how the claim was submitted, then I would call Medtronic to ask them to resubmit the claim correctly. If, on the other hand, the large amount in your bill is the result of a decision by the insurance company, see what your options are for appealing the decision (again, something that should be addressed in the benefits booklet) and enlist Medtronic’s help with this since you’ll have to provide documentation in support of your appeal.

I think it may be just poor descriptions on the billing, but I could be wrong.

4449 is the original amount, not what you owe.
3200 is the pathway price, without a trade in.
1249 is pathway price with trade in of another pump. When you actually send in the other pump, and they receive it, you are credited or refunded 500. So net is 1249 - 500 = 749.

It’s been years since I did a pathway deal, but that’s how it worked. They hold back a portion until pump is sent to them.

Call medtronic to confirm.

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We could return it , but my they would have to return the T-slim or my son would still be off-warranty. And, I didn’t include this in the original, but my son has high functioning autism-- meaning, he doesn’t like his routine changed. The lengthy and very different method of changing cartridges etc. was what really put him off. He has had very good control of his diabetes (A1c usually 6.0- 6-7), so we don’t want to mess with that by adding that stressor. So, yes, we can return the pump, and not sure if we will need to do so.

Thank you for your detailed reply and good information. I’m afraid I wasn’t so clear on the coverage aspect. My son has excellent coverage for his pump. We paid nothing for the T-slim, it was entirely covered. But we were not yet due for a new pump-- the T-slim was under warranty till 2020. So of course, we can’t use our insurace for any pump before 2020.

Originally, he had a Medtronic that he loved, but it wasn’t waterproof, and that’s important to him. When it came time for a new pump, he got the T-slim solely because it was waterproof. The problem is, over time he decided hated the T-slim and just wouldn’t use it. He’s high-functioning autistic and in good control, so we didn’t want to push it-- so he was using his old pump, a medtronic that was out-of warranty.

But because he’ll be leaving the country for a family wedding in Spain in August, I really needed him back on a pump under warranty. (He had a pump fail once, and being on warranty solved the problem by overnighting a pump to him.)

Anyway- we could not use our insurance at all for this pump; he used his coverage on the T-slim, and he isn’t due for a new pump until late 2020. But this Pathways Program seemed designed to answer our problem.

It is for people on a competitor’s pump who want to get under warranty on a Medtronic.
The following conditions have to be met:

  1. You must be currently under warranty on a competitor’s pump.
  2. The insurance rental on the competitor-pump must be paid in full.
  3. You must have more than 6 months left on the competitor-pump warranty.
  4. You must also purchase a CGM.
  5. Upon receipt of your new Medtronic pump, you must send the competitor-pump to Medtronic in a pre-paid mailer.

If these 5 conditions are met, the program allows you to purchase the new pump without using insurance, for 749.00. In our case, we knew the CGM would be fully covered by insurance.

Medtronic then transfers the balance of the T-slim warranty to the new-under-warranty Medtronic, and so we’d still be eligible for a new pump in 2020.
I hope I have explained this helpfully.

I sincerely hope you’re right. I tried calling Medtronic today, but it’s the 4th of July. The figures are in the Patient Balance Due column, but maybe there is some internal system that I am unaware of. For now, I’ll stop panicking until I actually speak to a representative. Thank you.

Good for you.

Many invoices start with full price, and then show reductions to get to the end price. I have seen many confusing statements such as that, and learned to call for clarifications before losing sleep over it.