Health Insurance

So as a disclaimer I am not looking for hard and fast rules, but mearly what the experience has been for others.

So this year is my first year dealing with health insurance more than just a cold because my 13 year old was diagnosed on Valentine’s Day as a type 1. Although I have learned a ton about deductibles, co-insurance, DME vs Pharmacy I have not yet encountered the end of a year. So working with my DME supplier they had told me to place an order for Dexcom supplies in October for 1 month, an order in November for 1 month and then a 90 day order in December since DME is 100% covered at this point and will be 100% OOP in January until I reach the high deductible again. Now we are working with Omnipod (we are just switching) and when I talked to them about this same thing the lady handling our account said that we can do that, however October will be covered, November will be covered, but only 1/3 of the December order (the December portion) will be covered and the other two months will be OOP. Does anyone else have any knowledge on this situation? I am just trying to figure out cash flow for the next few months.

That is pretty strange. I never heard of that.

I agree with the Dexcom supplier. Sometimes orders get delayed a few days and the insurance sometimes goes by “order date” or “ship date” so give enough lead time. I will be placing my last Dex order of the year around Dec. 15th and it will be for 90 days. That just seems to be the rational thing to do? If the order doesn’t go through then it doesn’t go through but I never had a problem with this before.

Thanks, that’s my rational thinking as well, but the lady at Omnipod was very sure that we would be charged 2/3 of it OOP. I mean in reality we are going to hit our deductible and co-insurance next year regardless, but it would make the beginning a little easier on the checkbook. So the net result is the same really.