Insurance Problem with Pump Supplies

Hello all…I’m hoping one of you can help with a medical insurance problem I am having with Blue Cross Blue Shield. I’ll try to keep this short. Basically, I have new coverage from Blue Cross Blue Shield and I am trying to get insulin pump supplies (e.g. Infusion Sets & Reservoirs) for my Medtronic MiniMed Paradigm 522 insulin pump. Blue Cross Blue Shield will not suggest a known supplier of pump supplies, but has directed me to a very long list of “Durable Medical Equipment and Medical Suppliers” to get my insulin pump supplies from. I’ve called close to ten suppliers so far and none supply insulin pump supplies. I’m guessing someone on the list I was directed to actually supplies pump supplies, but I haven’t come across them yet. According to Blue Cross Blue Shield I need to find a supplier that is “PPO contracted through local Blue Cross / Blue Shield?” I live in Stamford, CT. If any of you are purchasing Medtronic MiniMed Paradigm pump supplies under these circumstances, I would greatly appreciate information on your supplier so that I can contact them & get supplies. Thanks in advance to any and all of you interested in reading about my problem, and to those of you who can supply some information based on your supplier experience.

This seems like an obvious question, but did you just try Medtronic? I had BCBS in MA and now I have UnitedHealthcare PPO and both of them said in the benefits guide that supplies must be done through their approved suppliers. Under both insurers, I have just ordered directly from Medtronic and had no problems.

Hi Jackie, I have talked w/Medtronic & also ordered supplies from Medtronic under my present insurance. Medtronic has provided me with supplies & billed my insurance; however, the insurance $ coverage was very low & Blue Cross Blue Shield told me that I could only get better coverage from their local approved suppliers (e.g. not Medtronic). So in reponse to my direct questions to Medtronic on this issue that have given me one “possible” source in CT (Yale) & another in that is out-of-state. Medtronic also gave me the phone number of their local rep but this guy hasn’t yet responded to the voicemail I left him last Thursday. So I’ll keep trying the MEdtroinc rep & will contact the Medtronic suggested suppliers tomorrow. Thanks Jackie…

True - But I found with BCBS of MA that my copays were 33% less when I ordered through BCBS’ PBM (Express Scrips) than through Medtronic.

You don’t say which BCBS. They are all entirely separate companies which cobrand for national issues. This is significant because on some policies, pump supplies, although they are DME, are treated as “drugs” (even though they aren’t) and can then be supplied by the PBM contracted under your specific policy.

All of that said, if you have checked all of the DME suppliers covered under your specific PPO (this could vary from policy to policy), call your BCBS company back and tell them.

Agree that the insurance company should be able to tell you or give you a list of approved suppliers. Here in Michigan, I have BCBS and they contract with one company (middle man as it were) to provide all diabetes suppies (test strips, meters, pump supplies, etc). They told me who the approved suppliers are in my area. Before I switched to BCBS, I had an HMO and my Endo Office/CDE told me who was approved for my insurance company. Perhaps your CDE can help.

Annoying, but even specific people at your carrier may not have all of the information. One person may be able to give you a list of DME suppliers, but isn’t aware that your PBM can provide most or all of your pump (CGM) supplies and with lower copays. At a minimum, it is worth calling Medtronic and asking them what they will charge you in light of your insurance plan. Because they have a financial motivation, namely to sell product, let them do the work of calling your carrier and determining who can sell to you at lowest cost (to you).

I’ve found that with some plans, it’s best to get supplies through the medical insurance company; in other cases, the prescription plan. I’ve gotten my pump supplies through CVS-Caremark, my prescription plan, for years – until this year, when the copay rose and it became advantageous to go through the medical plan and Medtronic directly.

Two different plans, two different sets of copays, but for the same product.

I have BCBS-MIchigan and I get my supplies from Medtronic. I have had no issues with the insurance not paying for the supplies.

Hey Gerhart, I live in the Hartford, CT area and I get all my supplies from Minimed directly. BC/BS pays for all of them and I pay my 20%. Give them a call and speak to the insurance specialists first before you order.

Thank you for the feedback Richard…and thanks to everyone else who responded to my post & request for help. You’ve all provided some info that has been helpful to me.

I have had the same problem in Michigan with my bcbs. Do you have the name of the one company in Michigan that deals with insulin pump supplies. This would be greatly appreciated.

BCBS Federal provides a book every year that lists the approved suppliers. I am in Virginia, use BCBS Fed and use CCS Medical.

I don't have BCBS but I live in Michigan and get my supplies through Airway Oxygen, could see if they accept it. 616-247-1312 is the number I use to order my supplies.

I get my supplies from Medtronic directly. When my insurance has changed in the past I have called them and they take it from there and get in touch with my insurance and I ask them to get back with me so that I know what the status is once they have called my insurance company. They have always been great about supporting me with there expertise in this area.