Ontario ADP & 3rd Party Insurance


#1

This may be a niche question, but I'm hoping someone around here can help me!

I just started on my pump, which was funded through ADP. ADP provides a $600 quarterly stipend to help offset the cost of the supplies, however that doesn't cover the full amount.

I also have 3rd party insurance through work (Manulife) and am trying to get a clear answer on if and how they'll reimburse the extra cost after the $600, but I'm getting the runaround.

Does anyone have any experience with this that I could perhaps communicate to my insurance company? Because apparently they've never encountered this before *rolls eyes* Or no one talks to each other, which I think is the more likely scenario.


#2

I am in the same postion as you. Here is my understanding of it. My 3rd party insurance (Great West) will not cover infusion sets period. I can send in the costs for the reservoirs though. all other diabetic supplies like the insulin is covered by my insurance. I got the run around as well..they are of very little help.
I do my claims on-line so I am hoping that doesn't confuse them even more.
That said I haven't yet sent in my claim to them for the reservoirs but will very soon.


#3

Oh geez, really? It seems so arbitrary - why wouldn't you cover the delivery device? I mean, needles and needle tips are covered.

gah. good luck - I'll let you know if anything changes on my end.


#4

it's crazy...or they're crazy....or maybe just I am. lol


#5

$600 thats it? I thought it was 2600 quarterly? When I called manulife a few months ago about covering the pump they said they did up to 80 percent but since ADP covers it they needed info from the first or something of the sort...I'm surprised they don't cover infusion sets but they do reservoirs..very odd


#6

Nope, $2400 annual. ADP pays the total cost of the pump, though.

Man, the people I keep getting act like they've never heard of an insulin pump. I think I'm going to call our rep directly (we're a small group plan).


#7

The ADP also makes you wait 5 years instead of 4, which is the warranty period. They will only give you a new pump if the person has out grown the pump or if it is broken and can’t be fixed for a decent cost. I had an ani as vibe and switched to a medtronic 630g for the remainder of my warranty. In 2020 will be 4 years. My argument will be that I have outgrown the pump as I am not using medtron’s sensor. I switched to dexcom as you can restart the sensor to last longer than 7 days. My pump won’t suspend if I go low. So basically I have outgrown it.