I'm sending a shout out to all here who have encountered Edgepark Medical and the usurious/overpricing of their diabetes supplies! OMG I have been beside myself ever since this afternoon when I learned that my new insurance company is contracted with Edgepark for durable medical supplies, and - I kid you not - the same supplies I previously went through Animas (I doubt the brands(s) any of us use matters) to buy is listed at 65% to 67% OVER what the manufacturer charges!!!
This means my box of 10 Inset 30 infusion sets that Animas has a list price of $135.00 has an Edgepark Medical "catalog" price of $402.19! Every item at Edgepark is so overpriced I'm just sick.
How, in today's America, can a company get away with this? I have to pay my insurance 20% of the allowable - the contracted amount they have agreed upon with this company's (Edgepark's) usurious practices. If it works out to be more than the full Animas price of $135 I am simply not paying Edgepark.
There has to be an avenue of recourse to identify such injustice. I am floored! How can we band together to protect ourselves and loved ones from becoming victims of such unconscionable practices?
I've had a rough few weeks and this about sinks my ship. I'm seeing Attorney Generals, etc in my future. I want to stand up to this with every fiber in my being!
Thank you for listening my friends. I hope my discussion doesn't get pulled.
One voice may not be powerful enough, but many might make the difference? Just want your thoughts.
There's a lot of funny money in prices to/from insurance companies.
It really bites those who have to pay "full list" from these usurious/fraudulent prices.
e.g. if I had to pay "full list" funny money price for the bloodwork that is run on me every 3 months (including A1C), it would be $300-$400. But the "if you have insurance then insurance only pays" price is $20-$25. And what I pay out of pocket? $0. Nada. Nothing.
In most cases, insurance can insist that you buy through a selected supplier at inflated prices, but they can't "scam" you into paying more than your agreed to share. You need to look closely at your insurance explanation of benefits and see what is being paid. Edgepark may list their price as $402, but your insurance may have negotiated a lower price (say $150). If your co-pay is 20%, you should only have to pay 20% of $150. You should not have to pay 20% of $402 and you shouldn't have to pay any difference between the Edgepark price ($402) and the insurance negotiated price ($150).
My most egregious example was a vitamin D lab test, where I was billed the "rack rate" of $232 and then found that my insurance had a negotiated rate of $8. I also was offended.
This is very interesting to me. I just got informed that Animas is no longer an "in-network" provider for my pump supplies, and that I have to use Edgepark to get them now. I've read a TON of bad reviews about them, and I'm really not looking forward to having to use them, but if I don't want to pay full price, I don't have a choice. Super lame. I'll keep you posted on how things go, but you better believe if they go bad, my insurance company AND Edgepark will hear about it from me. This is my least favorite thing about having diabetes, the CONSTANT fight with insurance companies and suppliers. Animas was so good to work with, I'm really sad I have to switch. :(
I have Anthem through my husband's employer in Ohio. They previously had considered Animas an in-network provider, but must have re-negotiated their contract with them mid-year or something. I've really liked Anthem up until this mess. Hopefully it won't turn out to be a pain, but I'm not holding my breath given the sheer amount of negative feedback from other diabetic customers who have reviewed this company. Also, to Animas' credit, THEY were the ones that informed me my insurance no longer considered them a provider, in a very official letter, before I even called up to place another order for supplies. I recieved NO information about this from my insurance co. Super lame.
Oh dear. I too have Anthem, though I haven't heard anything from them. I know different policies are different (mine is CalPers). I also pay 20% through Animas but in addition Animas has given me 30% off of that for my low income level. I hope for your sake and Julie Ann's (and maybe mine and other peoples!) that something like bsc is the case where it's not really 20% of $402 that you have to pay, but some better negotiated price. What a drag!
In most or all cases, your insurance company does not pay the catalogue prices. When I first switched to Edgepark, the first rep told me I would have to pay those inflated prices until I satisfied my deductible. Well, I called back a day later and found out that the first rep had not applied my insurance rates to my prices. It turned out that everything I bought from Edgepark was cheaper than Medtronic and my pharmacy pricing. I don’t understand why Edgepark has their catalogue pricing so high, but in reality the prices that my insurance company pays are quite reasonable. Before I satisfy my deductible, I still get my insurance company’s contracted rate on everything.
I have been with Edgepark for a few years and have had very favorable experiences after I got over the initial hump of making sure my prices reflected my insurance price. Through the years I have found that every time I have had to switch medical/prescription suppliers, it’s been rocky at first and then quite good once everything was worked out. Edgepark, at least how it works through my insurance, is very good. My insurance has good negotiated rates with Edgepark.
That's so good to hear. I'm not as worried about how much things will cost as I am worried about how their service will be. All the negative reviews about them I read were people complaining about how it was like pulling teeth/herding cats to get an order shipped to them every single time they had to order supplies. I'm happy to hear that someone has had a good experience! It makes me hopeful! I'll definitely keep this thread posted about my experience as I make the switch over to them.
I never had a problem with Edgepark when I was able to use them. I have switched over to Diabetes Specialty Center only because I now have to order my Dexcom sensors as a pharmacy item and Edgepark cannot bill for pharmacy related supplies. But Edgepark worked with me even through insurance billng problems. I have no complaints with the company.
Thanks, Lathump. After reading this post earlier I found myself wondering what the heck was the point of an insurance company switching their provider to one that's more expensive. After all if we have (for example) 20% coverage, than the insurance company has to pay 80% so it would be to their advantage to get the best rates! Thanks also for the heads up to make sure if we get switched to them that we are being charged the contracted rate not that absurd catalog rate.
Deductible should be a four letter word.Especially since every single year I forget about it (ah, denial) and then go into sticker shock when I get a $500 bill. I love retirement, it just doesn't pay too well..lol
Update: So I've been in touch with Edgepark about getting my supplies from them now instead of directly from Animas. So far my experience has been good. My insurance co. (Anthem) must have negotiated a better deal with Edgepark than they could get with Animas (either that or Animas is trying to get out of the business of being a direct provider--anyone know if that's the case or not?) because my co-insurance is going to be about $50 less than it was when I was getting it straight from Animas. I don't understand how that could possibly be, since now there's a middle man involved, but who knows? So, we'll see. I'm cautiously optimistic at this point, and will continue to let you know my experience once I actually receive a shipment from them, but so far, so good.
I don’t know why Edgepark’s catalogue prices are so high. I’m sure that your insurance company has favorable negotiated rates with Edgepark and you will eventually see how much your insurance company paid versus what Edgepark charged.
My EOB’s (Explanation of Benefits) always show the astronomical prices that Edgepark and all my doctors charge. Then they show what my insurance paid and it’s usually about 50%. Labwork is the same way where insurance pays about 50% or sometimes way less.
As I said several months ago earlier in this thread, I have had very good service from Edgepark.
