My insurance will cover pump, CGM, the works at 100%. Yippee you say! Me too, BUT I have a $5K Durable Medical Equipment annual cap on my insurance. Since the pump is over $5K by itself, all the infusion sets for the rest of the year (after using the 3-4 months worth that come with the pump i guess) will be out-of-pocket, as will (obviously) the CGM and whatever supplies THAT calls for.
I have heard through the grapevine that sometimes you can get your insurance co to lift that cap for the current year so that you can get all the stuff you need covered if you ask. AND I have considered asking our employer to lift it for us for this year as another approach.
Anyone tried anything like that with any success? Plan B of course is to wait until Aug or Sep to order a pump so that the next supplies will fall under the next insurance “year”.
Does that even make sense?