So I got my new pump 670 G I finally got the sensors. Now I am waiting for my Insurance to say my pump will be covered. I thought that it was already established but apparently not. Is anybody else having this much trouble ?
That seems very strange.
For both of our last two pumps, neither Animas nor Tandem would ship the pump before getting the approval from the insurance carrier.
I certainly hope it all works out for you without making you jump through hoops.
Same for me and my last 4 pumps. Nothing sent until after insurance is confirmed.
Thanks! Maybe I just need to count on it when ever I get a new pump. This is only my second pump.
Medtronic would not have shipped the unit if it were not covered.
In ‘the olden days’, some years ago, some people occasionally had to ask the doc for a letter stating ‘medical necessity’ for certain devices. Sometimes this needed to be submitted and argued about, multiple times. But, I thought that stuff had gone by the wayside.
Still necessary if you do not meet the guidelines (often based on diagnosis code) according to the insurance company or if you want something not on their preferred list.
To a degree this makes sense as there will always be people looking to game the system and ask for expensive things of which they have no actual medical need.
Although these people are very few and certainly the exception, the reality is they make life difficult for everybody else.
And then some insurance companies simply take it too far and get absolutely crazy over that which should obviously be covered.
The person that I know who had to do this was a paramedic with a full time hospital policy. He was a type II, applying for a Dexcom. He is the one who first introduced me to a Dexcom, so I think it was early in their development (it may have been ten years ago).
Yeah - T2 is still not covered for cgm (without appeal) under all insurance. One particular big insurance carrier comes immediately to mind.
I did get a CGM thru Coventry, my insurance of the time. They insisted I do a 2-week trial first and send the data to them, but between the lows I was having and my partial hypo-unawareness, they approved the Dexcom. When I later had to switch to United Healthcare, I had to repeat the authorization process; however, the evidence they wanted was (by definition?) unavailable – they wanted to see the “serious lows” I was getting, but as I was using the CGM at the time, I was managing them before they became serious!
Joke is that when my endo asked UHC to approve a pump (because I was getting regular mild lows), they refused, saying that they only approved pumps for excessive HIGHS, but would approve a CGM for lows – then they promptly denied the CGM as well!
And yes, I eventually did get approval for the CGM from UHC. Never got approval for the pump, but a quirk in their processing allows pump SUPPLIES even for people who are denied pumps. Go figure.
While this might be true in some timeline and some places, theoretically, I can’t imagine anyone wanting a pump or CGM “just because it’s expensive” without medical need. Maybe if there exists some kind of pump and CGM blackmarket, but I don’t see too many people going cyborg just for cool stuff.
Seriously? The concept of people fraudulently obtaining expensive medical equipment and reselling it on the black market?
It is a reality which insurance companies need to protect against.
That sounds like a nightmare! UHC is the worst.
It was not fun, yes. My employer had to threaten to take his multimillion
dollar account from them to get things fixed. I’m currently on Anthem and
Express Scripts - a whole different class of challenges!
UHC = United Health? http://www.startribune.com/feds-sue-unitedhealth-alleging-false-claims/422660714/
I know a guy who works on Express Scripts. Whats the deal with that?
It was a combination of policies and errors – and I’m still not sure what the resolution is… First, my prescription was sent from my endo for Apidra @ 90u/day for 90 days, or 6 boxes of pens. They denied the Apidra since only Humalog is in the formulary. Somehow my endo’s office (supposedly) approved the changed to Humalog, despite my allergy to its ingredients, and without notifying me of the change. A couple days later, FIVE (5) boxes of Humalog pens were delivered for a $150 gopays
As I can’t use Humalog, I called and told them, took a while, but they (a) agreed to let me return the Humalog, and told me to get my endo to SEND, a Prior Authorization (PA) form. Endo’s office said their experience is that Express Scripts sends THEM the request for a PA for (along with the form) - a couple phone calls later and the form materialized… and… ONE box of Apidra pens was delivered. THEY claimed that the endo’s script said to dispense 6 PENS (not boxes) for a $90 copay (why the difference?) - BUT, since no new script was sent, why were 5 boxes of Humalog OK to dispense, but only one box of Apidra?
When I complained, they told me to tell my endo to send a new prescription, and they gave me a $50 copay credit against the other $90… HOWEVER, I had to pay the $90 copay before any of this could be implemented… After that, I finally got 6 boxes of Apidra, for another $90 copay, of course, and a letter telling me that their new policy does not allow them to accept certain medications (like insulin) in returns with instructions on disposal options.
I currently have NO IDEA how much I actually owe them after all this… $90? $130? $190? Or… what? Nothing? (I’ve received no followup bill…)
The website shows me absolutely nothing useful, so I can’t check my account there…
Oh Lord, that’s tricky. I dunno how you figure that out. Time may tell, but that’s a lot of footwork to resolve. Bummer. Sounds like me dealing with my distributor. If they can’t deliver the goods reliably, then they are just another inhibitory middle man that makes the whole system break. You should let us know, in the future, how this works out. Maybe its just a one time problem…but, that’s awful optimistic.