Pump Insurance Approval

#1

I need some advise. I am an Animas Ping pump user. I will be staying with the Ping at least till August. I have my Endo appt in August and would like to ask my doctor to submit to my insurance for the Tandem X2 Slim pump. Here’s my problem. My Animas pump warranty doesn’t expire till January 2020 and Animas will stop providing supplies for the Ping in September, so they say. What is the likelihood my Sharp Community Health Insurance would approve a new pump 5 months before the warranty expires on the one I have? Or should I just wait and request a new pump in January once the warranty has expired? Please advise.

#2

I would like to think that your insurance will take into consideration that you can no longer obtain pump supplies. A letter from your doctor explaining the situation would help.

#3

@Elisa1
A general expectation is that many people would have been able to stockpile a certain amount of supplies to carry them a period of time past September.

Some distributors may also have remaining inventory they could have available. I would call your distributor (and find any other distributors you can order through your insurance) and ask them.

Potentially you could switch to MDI for the time period when you run out of supplies until you are able to obtain a new pump.

Potentially somebody with extra Ping supplies could send you a PM if they no longer need them.

Certainly there is no downside to trying to obtain a pump approval from your insurance earlier. The case you make is valid and certainly not the first they would have heard of this. Thousands of people are in your same situation.

FYI: We also were on the Animas Ping and then switched over to the Tandem t:slim X2 pump. It has been very nice and greatly enhanced with the Basal-IQ algorithm which of course requires the Dexcom G6 to operate. However, I still really miss the Ping remote - that was a VERY nice option to have.

I would suggest to send a message to your Endo now. Why wait until August? Everything takes time. Unless you think an in-person conversation would be more effective than remote via electronic messaging. I am used to frequent electronic messaging with our Docs so I simply may be more comfortable with that approach. Plus I get distracted and forget so if I already started the conversation then I don’t have to worry about forgetting to bring it up during the in-person appointment.

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#4

Thanks I’ll make sure the Dr. writes a note.

#5

I love my ping so much I’m not quite ready to make the change. I’m hoping I’ll be ready by August. Thanks.

#6

@Elisa1
I totally understand.

We ran our Ping two years out of warranty even after it had numerous issues. We really did like the Ping. Nothing lasts forever so we did have to switch. As it turns out, the switch was advantageous but still - we did like the Ping.

#7

Have you asked if they might be able to provide enough sets to last to Jan?

I use MM sets and have extended days of use, to make sure I have a few backups.

Also check if your endo might have some, possibly another patient donated their extras when they switched.

#8

I don’t think the warranty has anything to do with when you change pumps. I’m pretty sure that I could change pumps every year if I wanted to pay the durable medical deductible. I would call the phone number on your insurance card regarding member services/benefits and ask. Explain the whole situation. They might be able to suggest something. I, personally, find it difficult to stockpile pump supplies, but you might be able to save up a month or two extra by ordering just a little early each time.

#9

Our insurance will only cover a pump when the pump warranty expires (which in USA for non-medicare is typically 4 years).

Outside of that, our option would be to bypass insurance completely and pay cash for a pump.

Omnipod may be entirely different. Obviously the PDM (pre-Dash) does not have an upfront cost in the same ballpark as a durable tubed pump.

#10

Same for me since my first pump 20+ years ago.

#11

You may be able to get your insurance company on board if your Endo is willing to write a medical justification that in his/her opinion a pump is required for you to have adequate control and that MDI isn’t sufficient.

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#12

Couldn’t agree more. I had every generation of the Animas pump line. They were rugged, reliable and easy to use. I also liked the company before J&J got involved. But the tandem pump is a superior product and I’m glad my hand was forced.

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#13

Wow, that makes changing pumps a really big deal, then. Shoot. I always thought durable medical was kinda flexible since it seems like so much of the $$ goes to non-durable supplies. Thats interesting.

#14

Over a four year period for the Tandem, about half the cost is up-front with the pump and the other half are the pump supplies over the four years. That is USA. International is a bit different. No idea about Medtronic. Omnipod is clearly very different with minimal up front cost and larger ongoing costs. I didn’t calculate but my gut feel is over a four year period that Tandem and Omnipod end up in the same ballpark but I could be wrong.

And from an insurance perspective, everything (Tandem) is durable. The pump is durable so everything associated (ie supplies which clearly only last a few days each) with that is durable and under DME. From an insurance point of view.

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#15

Yes.
It was very difficult to pick a new pump.
Hence we stayed two years on the Ping after the warranty ran out and we had a number of problems on the pump.
But it is a big decision to switch pumps.
And I just did not want to switch until we were really convinced we had made the best decision.
It is not easy.

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#16

@Elisa1 on the Animas Ping website they state that if your pump is in warranty, they will give you a 670G or a 630 Medtronic free of charge since J & J wants to be out of the Insulin Pump market by Sept 2019. They also say that Medtronic is able to assist in obtaining Animas pump supplies. They state in the below link :

" If you are currently using an Animas pump and pump supplies, you will continue to receive pump support and services. Animas has transitioned customer service and customer technical support to Medtronic. If you have any questions, technical issues, or need to order supplies for your Animas® Vibe® and OneTouch Ping® insulin pump, call Medtronic at 877-937-7867 (US) or 800-284-4416 (Canada). As part of our continued commitment to patient care, Animas will honor pump warranties; however, the method of fulfilling those obligations may change in the future. Click here for the latest information on the Change in Warranty Fulfillment."

I have attached the relevant web link below in case you would like to read the complete letter.

Animas Patient Letter

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#17

They (Medtronic) are going to stop providing supplies to those of us still using Animas pumps once we roll into September.

While I hope I’m wrong, I’m convinced of this.

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#18

I think that is a fair assumption. They are incentivized to roll people into a Medtronic product as quickly as possible.

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#19

Yes but I don’t want a Medtronics pump. I want a X2 Slim.

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#20

@Elisa1 according to the Tandem website, in-warranty pumps can be exchanged for a Tandem pump for a one time fee of $999 via the Tandem upgrade plan. Not sure if that helps. I personally like my Tandem pump very much.

Tandem Upgrade Plan Link

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