Been on my Insulin Pump for almost 18 years. It died after out of warranty. I am on a loaner from Medtronic. I may need to go on Lantus along with Novolog which I haven't done since starting my pump. It's a cost issue for me. I am very scared. I have BCBS PPO of Illinois and I live in Texas. I am trying to find what Pump companies are covered but having a very hard time. A guy I talked to on the line from BCBS told me to look under providers but I'm getting NOWHERE. Has anyone done this? Anyone have any suggestions as to where to find this information on the website?? UGH, I don't want to stop pumping, but I may have to. Just need to to and ASAP.
I’m no expert on these subjects but if the pump isn’t covered by warranty then isn’t insurance on the hook for a new one? In the few brief interactions I’ve had with pump companies, their sales reps have been all too eager to do the legwork and deal with the insurance companies to get it approved. I’d contact Medtronic sales or any other pump sales dept that you are interested in and let them fight the insurance battle for you, or at least help with the process
I've met all but $175 of my medical device deductible, so that is what I would have to pay of deductible, plus 20% of the price of the pump. Medtronic now only offers the Paradigm upgrade which also includes the CGM which I DO NOT WANT, but it comes with it like it or not. SO, I would owe, approximately $784. I guess that's not bad. My husband says, that's a huge hardship for us right now.
Ditto Sam and MegaMinxX
The Revel does not require you to use the CGMS - this is from the MM site:
Your MiniMed Revel Insulin Pump comes CGM-ready. When you want added protection from lows and highs, simply add a transmitter and glucose sensor to your MiniMed Revel Insulin Pump.
So do call MM and/or reach out to your rep. Did something happen to the loaner??
Hi danadoll63, I can understand your frustration, Im not sure I could go without my Ping now that Ive had it for so long, and to go back to the "lantus lows" ...Id rather not...As far as insurance coverage, I don't think they list insulin pump brands in their "formularies" as pumps are DME.. I believe, and correct me if im wrong, that whatever your Endo writes up as "Medical Necessity" no matter what pump company it is...when I had insurance they tried pushing Medtronic on me, and I insisted that I wanted to go with Animas...My Endo wrote it up as such, and the insurance co got me one, no prob.
What I have right now is an MM Paradigm 722. This Revel and the 530G (is this the new upgrade) not sure what that is, but I would love to just get another paradigm. I had just made a new pump supply order and haven't even opened it yet.
I have a really short period of time here to make a decision so I am going to really have to try to find a rep. I hope my doctor can get back to me and find one for me. With what is left of my deductible and the 20% coverage for medical devices, I would have to pay about $790 for this new "system". I guess for some that sounds pretty good. But we just do not have it right now. So I either have to find just a pump for less, or go back to Lantus/Novolog pens. Thank you, thank you for all of this helpful advice!!!
No, my loaner is working just fine but the days are ticking down for me to need to send it back. They are processing my order and I need to make them stop.
Thank you Jaybyrd, very good information to know. I have an endo appt. a week from this Thursday, wish it was sooner. I want to be able to talk to a MM rep before then though.
I don’t think you’re going to find a “cheaper pump”. Your insurance benefits are your insurance benefits and probably would apply to all pumps. Most of the pump companies offer payment plans for the copay and that’s where comparison shopping may be beneficial. A few years back when I was researching pumps Accuchek had an offer that would basically write off the copay though. I don’t know if they still are doing that.
Also find out whether your malfunctioning pump can still be used as a trade in. That would reduce your copay significantly.
I think Diana has a good idea. MM has made a LOT of money from you over the years, and they don't want to lose you. You may be able to talk them into a trade-in on your existing MM pump. Or at least a deferred payment for the copay. It doesn't hurt to ask - the worst they can say is no. Things like this are often negotiable if you can talk to the right person.
I've had a few issues but I always call Medtronic and let them feud with Blue Cross (I'm in Illinois so I'm although through BCBS IL/TX/NM/OK/MT, etc.). They seem to get it done. Whenever I call BCBS, the answers infuriate me and I think I get stuck in loops. The RX's work ok but I do pump stuff through the manufacturer.
Check with your insurance! With some BCBS policies, DME is covered 100% after deductable is met. Your out of pocket may be less than you think.