Insurance question

Does anyone have any idea why my insura ce company won’t tell me what pumps etc… They will cover and they say they are not brandspecific. However, the supply companies I have to use tell me my insurance won’t cover this or that. It seems like a game. Also medtronic where I have to get my pump unless I choose a Tandem won’t give me the 670g because they dont
Rembursed enough money . Sick, just plain sick. My doc wants me on the 670 because it will shut down my pump if I drop too low. They also said insurance wont cover the cgm thatgoes with the 630g. I don’t feel the highs until I am 500 and am not feeling lows until I am lower 30,s.

If your preference is for tandem, then my suggestion is to ask tandem to check with your insurance company. They typically know who to contact and what info to provide to insurance to check coverage. This is how it worked for me in the past with medtronic, and my employer kept changing the insurance provider.

If you have an employer based plan, there may be specific coverage, or non coverage related to pumps, that the employer controls. So your HR or Benefits dept is another place to get help.

My doc pushed me and pushed me and lead me to believe 630 was better so I went with that. I HATE IT though. I packed it up in its box and am going to use my Animus ping until I absolutely cant.

To be honest, no one said anything to me about how the Random works or that it even existed.

Tried that. Our insurance has us deal with dimensions for all durable medical equipment. They said we are not brand specific. The supply companies I have to use simply say I can’t get this or that. I worked with Soledad for weeks only to be told they couldn’t get me The 630g that in fact they never could get me any medtronic pump. I was so angry after all the work and phone calls and waiting.

Maybe your insurance company has formulary and the pump your doctor prescribed doesn’t meet that requirement. Please ask your insurance if they will waive the requirement. This can be done by having your doctor offer a letter of medical need. Good luck jewels.

Thanks so much Karen. My doc documented my need and insurance approved pump and cgm but supply companies say insurance will only cover this or that. The thing that gets me is the secrecy. The supply companies play games. They only give say the 670 to people who can pay full price or whose insurance will pay full price. It is a money game. When will doctors be able to run healthcare instead of Medicare, insurance and drug companies?

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Out of curiosity what is your insurance company? Generally if you contact a pump company they will work with your insurance to qualify you for and provide a mechanism to receive a pump. If a pump will not not work the manufacturer will usually know that fairly soon in the process and will direct you to the a different company.

If Medicare is your insurance there are very different rules and those rules are both more cumbersome and more open. I wonder if, from your post Medicare might be your provider? If so all three US companies can be used, but not all pumps made by those three companies are eligible. It might also be that you have United Health Care at which case they have a very high preference for Medtronic pumps. Hence my question about the insurance source.

Insurance providers often do regulate the manufacturer as well as the supply company that has to be used, but you should remember pump companies are in the business of selling pumps. So if you wish a particular pump they will usually work to qualify it.

One note about the 630G it has both low and high alarms if used with the Medtornic CGM. However Medicare does not provide CGM coverage for Medtronic pumps.

Medicare does not provide CGM coverage for Medtronic pumps.

That may no longer be the case. I was just informed that my appeal to have my Med Advantage plan pay for sensors for the 670G was approved. I haven’t been reimbursed yet, but I’m optimistic.

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Thats ridiculous. I agree, it sounds like a game. I would document that and call them out on it. Write a letter to someone at your state government.