Finally approved

After much fighting with the insurance i logged on today checked my email and saw a note stating that im approved!!

Woohoo! All the hard work finally paid off! Congratulations and happy pumping :slight_smile:

Congratulations, Andrew, and welcome to the Club!

CONGRATS!!! Very happy for you!

Congrats Andrew! It’s life-changing, happy pumping!

Congratulations!!! Nice work getting the approval.

im kinda upset…We just figured your co-pay for the insulin pump and supplies. As I had mentioned before when I disclosed your benefits to you, you have a $5000.00 calendar year maximum. So far, the Dexcom monitor and 3 boxes of sensors have been applied to this maximum. Therefore, $2,191.04 has been met of this maximum, leaving a balance of $2,808.96 for Durable Medical Equipment.
Once your insurance company processes the claim, the balance you will owe on the pump itself is $1781.04 and for three boxes of infusion sets, you will have to pay $435.00 as the pump is maxing out your calendar year maximum. You will have to pay $78.30 for 3 boxes of reservoirs.
The total due now to order and ship is $2294.04. For all future orders, you will have to pay $435.00 for 3 boxes of infusion sets and $78.30 for 3 boxes of reservoirs and $350.00 per box of sensors.

i was told that it would be like $150 for 3 months of supplies but now im being told its like $600 i dont like this one bit its almost seems like i was being led on =(

Andrew, unfortunately we all have these policies with different copays and situations.
I’m sorry you ended up not knowing what you would owe.
I personally dont go by insurance agents anymore (because they never quote things right on pumping stuff), but then again I am self employed and select my own plan and copays.
You’re going to have to weigh it out with the insurance co, pump insurance dept and whoever was helping you with this. It may be that you can find a different way to get the things you need, but then again maybe not.
If you were sold the Dex under a misunderstanding, you might need to talk to these people and let them know they messed you up. I would have thought they (whoever they are) would have been more careful.
Keep us posted and blessings, I hope you can keep your DME and supplies.

You might want to check with your insurance company. It was my understanding that the new healthcare laws did away with maximums on durable medical equipment benefits. I had a $15K maximum in prior years and this year the ceiling was lifted.

oh well i have bluecross blueshield of south carolina or florida i forgot which it is

Work on it as soon as you can Andrew.
You’ve got to get to the source…your policy and what it says, and whoever was working on this with you.
Dont give up, but work on it right away. It can be frustrating dealing with all the confusion, but you can do it!

Wow… so sorry to hear that. These insurances get away with murder. :o(

Mine is Blue Cross of Louisiana. I’m thinking it doesn’t really matter which insurance you have, there may not be any maximums anymore. Check with Blue Cross.

well i was just told after i get my pump i will be responsible for the rest of the supplies for the remaining part of 2011 which is gonna be quite alot of money i might just pass on the pump though it would better my a1c to a normal range and prevent me from having future complications i hate insurance

Andrew, if you could swing the pump and not do the Dex rigth now it would be a good plan.
You can always add the Dex later.
Just a thought.
Many of us cant afford the Dex, but there are ways to make your pump supplies last a tad longer and it is more affordable I think…

Andrew, sorry to hear of your insurance hassles. I agree that you might want to skip the Dex at this time. I also have had a couple people say that starting both at the same time was very overwhelming, so maybe it’s for the better.

I do want to tell you that Animas has a program where you can get a 30% discount on supplies if you are under a certain income level. If you think you might qualify, contact your Animas sales rep to fill out the paperwork. Good luck.

well my dr wants me on the dex due to my hypo unawareness so even though i would do better from the pump i think i benefit more off the dex

my insurance just said i have $5000 to spend per piece of equipment and also that they are filing my supplies under dme which insurance doesnt usually do it like that… i think a feeling im getting screwed over it so i emailed the rep inquiring about all this and the 30% off as well i only make like 25k a year or so anyway

Good, maybe you will get answers.
I know my supplies go under Home Health Care (disposable supplies).
Maybe you’re on to something with that…

Then you will definitely qualify, Andrew. I think the cutoff for a single person is $38,000 (higher for a family). I have 80% insurance coverage and I qualified for the discount, so it paid the remaining cost of my pump. I then get an additional 30% of supplies. It helps!