Has anyone run into the problem of insurance company not covering the cost of
diabetic supplies for the pump?? When I ordered supplies the rep from medtronic
said I was covered up to so much and that’s what we got supplies up to,
now I’ve received a bill bc insurance company may not cover it. Any suggestions on what to do?
Are you insured thru an employer or how?
You have to find out what your policy says, and this can be very different for different companies.
Somehow you have to get to the proper person at your insurance company, or make Medtronic do it for you.
If you’re employed, it’s still better to get hold of the customer service dept yourself because few employer’s are going to understand what it is you’re trying to find out.
Best wishes.
I agree with Laura, call your insurance company. Some companies have limits on their DME so if something else goes thru DME (like your test strips), that could have hit before the pump stuff and maxed you out. Also, you may have to get supplies from one of your insurance companies providers and not directly from MM. I used an Animas pump but had to get my stuff from a supplier because Animas was not a provider with my insurance.
Medtronic was the one that contacted the insurance due to the fact of getting a different insurance. When I gave her my new information she informed me I was only good for up to $500 worth of supples, so we only ordered supplies up to $500. I don’t know if she read the information wrong, or what. I’ve called my insurance company and they told me they usually do not supply coverage for products such as an insulin pump, which is all confusing to me. When Medtronic looked, I was covered, and now that I am calling I am possibly no longer covered with it. I no longer have that insurance, but have a bill that I cannot afford to pay. It all is starting to become a headache.
When you say diabetic supplies, what are they not allowing? You can ask your insurance to review your needs and give you a waiver for supplies. Medtronic and other pump durable suppliers simply verify insurance and bill them…they do not define or determine your coverage. It is your insurance, call them and ask them to cover your supplies. Since you already have the pump, they may waive whatever limitations exist on your policy. Good luck, it’s a hassle to be sure but worth the fight.
If I am understanding what you are saying, it sounds like you have an annual maximum benefit of $500 for DME. You will need to contact your insurance. You need to ask them what your DME coverage is? Is there an annual maximum on your DME? What is their procedure for filing for an exception? Also, do you have prescription drug coverage? Sometimes you can get your supplies through your prescription coverage. I know wiith my insurance I have a choice to either use my medical or prescription coverage for my supplies. When you talk to the insurance company you will need to keep a record of who you spoke to (name, date and time). You will need to be very clear about the information that you need. Good luck and don’t give up.
More important than calling is reading the exact "Medical Policy" which apply to your specific policy. These will likely be available online, by fax back or mail. You need to determine what is meant by "pump supplies." Are you talking about infusion sets & reservoirs or are you talking about other items? Some policies cover certain items under the drug benefit (although they may be supplied by another company) and some cover them as DME. If DME, most policies have an annual limit and you may have hit it.
But, the key is not to rely on what people tell you, but what you read. You would be surprised at how many customer service types just don't know what they are doing. Once you have everything lined up, then it is worth a call.
I have to agree with the others. As difficult as it may be you will need to learn some of the basic insurance parlance and read your actual policy in detail to understand what coverage you may have and what options you may have should you want to request an exception to that coverage.
While it does not matter what seems 'right' I do have to say that I don't think you would have a $500 annual limit on DME if you are on any sort of normal private insurance...but the only way to know for sure is to check!
Good luck!!!
In addition to checking out the DME vs. Prescription issue check to see if your state insurance laws have any requirements about covering diabetes supplies. My state law says that insurance companies must cover certain diabetes supplies which includes test strips, pump supplies, diabetic foot products etc. I’ve had to pull it out when they refused to cover ketone strips before.