So I’m in the market for insurance through my job.(YAY!!!) But now I have numerous options and many decisions to make. I refuse to just make a decision and be covered. I’ve been researching my butt of and not just what they offer but the company too! I was insurance illiterate 3 days ago,now I get it!
SO my question is…
which should I pick
Here’s the breakdown! (by the way all deductibles/copay’s/pharmacy are the same)
AETNA(cheapest) has numerous pump companies in network but not Tandem(I want a new pump) they do have a company in network(Edgepark) that sells tandem pump supplies! I also want a CGM and they cover that too no problem! Also they have the doctor that I want. My problem is I don’t know how reliable Edgepark is. The customer service was friendly I guess,they weren’t horrible!
CIGNA(6$ more than aetna) has a middle man(CareCentrix) that everything goes through. The insurance lady called and they said they cover tandem. But for my CGM I need to have my doctor prove that the TRANSMITTER is a medical necessity.(like for real!!) So my problem with that is two fold… I don’t know a thing about CareCentrix and I don’t like the extra hassle of proving that the component to making my CGM work is a medical necessity. Good customer service
BCBS(The most expensive 14$ more than Cigna)
Excellent customer service…literally on the phone with the lady for like 45 min! And she crunched numbers for me. They work directly with Tandem…which I feel could be more expensive for me,but less of a headache. CGM is covered by them!
Meh. I would go with BCBS too, even though they tend to suck, because they suck less. Then Aetna, then CIGNA. I base this off of the fact that in my previous career BCBS only made me mad enough once to bring out the Southern accent, whereas I with CIGNA it came out so much that I think they thought I was still in Texas.
So it looks like BCBS is $20 more a month than the cheapest option. They cover your CGM and won’t make you jump through hoops for that. They cover the pump you want, and won’t make you jump through hoops for that. In all likelihood the doctor you want also accepts BCBS? Most doctors do, as they seem to be one of the most widely accepted insurances.
The question is… how much is an hour of your time worth? If you’re having to call your insurance, suppliers, etc. and fight about stuff all the time to get what you want/need covered… is it worth that $20? Personally, my time and headaches aren’t worth saving $20 a month if I can actually afford it.
When you said that all the deductibles/copays/pharmacy coverage are the same - did you actually look at the pharmacy formulary closely? Meaning, not just what the tier breakdowns, but make sure that each of your medications are covered, and that they’re in the same tiers? Did you make sure that each company covers the same max number of diabetic test strips, etc.? Did you look at things like discounts for 90-days supplies?
Also, some “flavors” of BCBS have a program where you can get discounted gym membership. I wrote about that here: Health Insurance & Gym Discounts If you like to go to the gym, or want to join one, it may be worth looking into seeing if AETNA or CIGNA offer the same sort of program.
BTW, As far as suppliers go, my particular branch of BCBS is letting me use a company by the name of Pumps It, Inc. for my Dexcom supplies. They also deal with Tandem insulin pumps. I haven’t worked with Edgepark before, but so far I’m really liking Pumps It. They’re a smaller company without all the red tape and chaos of dealing with a company with 100s of employees. Granted, that does mean they don’t have 24/7 service, but I’m OK with that. They’re in Houston, and I’m in San Antonio, which means fast delivery without having to expedite shipping.
I work for Walgreens…so I can only use Optum Rx for my pharmacy needs. That is why I said that they all have the same pharmacy. I’ve done my reasearch. I would pay the exact same for my insulin which is excluded by the way…nothing I can do about that but I can take humalog which is in teir 2…40$ copay for 3 vials! They way my options are…they cover the same thing. I don’t really have differences in coverage until it comes to what’s in network with pumps and cgms! I don’t have a doctor because I was insurance less for 2-3 years so i would just like to see an endo! Which I’ve checked is covered by all 3 of them! Like I said the only thing that differs is what’s in network with DME and who they go through to obtain that! I and price! I’ve never had a private insurance before so I wanted to know difference between companies.
Good for you for all your research! Informed decisions are so important.
A couple of times, I have taken all my expenses for one year (doctor visits, labs, pump supplies and pharmacy) as well as deductibles and out of pocket max, and our portion of the premiums, and pretended that is what I would spend in the coming year. Under all three options for insurance, each time the amounts we would spend were amazingly close. Employers work with the insurance companies so it will come out this way. Most aim for a 80%/20% split until you reach out of pocket maximum.
I never did as much research as you, though, by looking through formularies and DME coverage. If you know all of your expenses, you might try the approach above, too.
Aetna isn’t bad, I had them years ago for a brief period in time. I am currently using Edgepark as they are contracted through my insurance carrier along with Liberty. FREAKING HATE LIBERTY, they are awful. So far so good with Edgepark. They processed my order quickly for my Tslim and I had it in a little over a week from start to finish. BCBC is good and pretty much most doctors accept it. Got my first pump and CGM through them with no problem and worked directly with Medtronic. Once again it was a quick process from start to finish around a week, or just a little over. BCBS though, I think their pharmacy benefits suck, especially with a newer medications. A lot of people I know have had a lot of issues with newer medications it being covered under one plan, but BCBS wouldn’t cover it. Of course this is for newer medications. Standard insulins like Homolog/Novolog…if u use basal insulins like Lantus/Levemir shouldn’t be any problems getting. I’d stay away from Cigna…had them too at one time and it sucked majorly, everyone I know that has had Cigna has had problems with it.
Be careful with cigna. Even though they say an endo is covered, make sure that the endo in your area will accept a new patient on cigna. When I changed jobs and had to use cigna, the only one I could find that would take me was 2 and a half hours away. The one I had used for years saw cigna patients, but wasn’t allowed to see any more cigna patients. Apparently, their reimbursement rate was really, really bad! Because it was so far, I couldn’t go as often, but I really disliked the doctor anyway. I have a different job and different insurance now so I can go see a closer dr.
