I’ve been unemployed for the past 4 months and obviously getting insurance coverage has been difficult. I’m a type 1 diabetic for 25 of my 26 years and have a 6.4A1C, 100% raw vegan diet, so by all means the diabetes is under great control.
I'm kind of wanting a Dexcom 7+ to get more anal with my control. There is an insurance company that has accepted me for coverage if I so choose. They said I would have to pay 33% of the negotiated rate for the dexcom and then 33% of the cost of pharmaceutically available diabetic supplies.
What exactly are pharmaceutically available diabetic supplies? I'm guessing I'll be shafted and have to pay 100% for pump supplies as well as dexcom sensors...
Does anyone have any experience with these kind of coverages?
Here is what I have seen with insurance coverage. The negotiated rate is alwasy seriously lower than what people pay out of the street without no insurance. There should be a code book that they can provide to you that will have what they cover and what is the rate they will pay. I have never seen this on medical but on the dental side there is a code that I provided my insurance company, then I would find what the item or procedure was and how much it would cost the insurance company. So if a person out of the street pay 800 for a procedure, the insurance negotiated rate was 300 and I would pay 20% of the 300 so I wound up paying 60.00 for the 800 procedure. So see if the company can provide you a chart with how much things could potentially cost
Yeah I was assuming that negotiated rates are drastically lower than out of pocket, so that’s good to hear. I need to track down one of those rate sheets and from there I can do an analysis to see if it really pays to get this insurance. In general I’m anti-insurance, my healthy lifestyle is my insurance. Emergency medical coverage…whole other story.
…
Hopefully dexcom sensors are a prescribable item available at pharmacies, only costing me 33% otherwise if not pharmacy available I’d have to pay 100% out of pocket.
My pump and CGMS supplies have always been under DME rather than the pharmacy benefit. I think that’s typically more common.
You could call Dexcom and ask them if there are any suppliers that can handle sensors under the pharmacy benefit. I know when I ordered my Dexcom they were great in finding a supplier that was contracted with my insurance as they were not.
