Pump Supplies vs. DME?

Hi everyone, as of July 1st my insurance coverage has dropped from covering Durable Medical Equipment at 100% to only covering it at 70%. I’ve noticed a couple of conversations on here where people get their DME only partially covered but have full or much better pump supply coverage. Could someone in this situation tell me how their pump supplies are covered? Is there any specific key phrases or plan categories I should be asking my insurance company about? Thanks!

Hi: I’m self employed and shop my own insurance rates.
We go in as two individuals of a small business on an HMO type plan.
My pump supplies are paid 100 percent under Home Healthcare supplies.
Very nice.
My DME however is 50percent.
Last pump I bought, I had to pay $2500.
Not so nice…
I would have had to pay around $1000 per month for my hubby and I to have a plan which covered DME at something better than 50 percent.
Of three different types of HMO plans, we picked the best of the bottom third.
More DME coverage will probably equal higher priced plans.
Hope this helps, sorry you have to deal with the situation at all.
My second pump was fully covered, so I know what it feels like!

Our insurance (HealthNet PPO) covers DME at 80%, after we meet our $500 deductible (per child). However we have a yearly family limit of $1500 for DME. Once we meet or exceed our DME limit everything is classified as “Diabetic supplies”, again covered at 80%. There is a special line item in our insurance plan for diabetic supplies not provided through the pharmacy benefit.

I have heard (from the Minimed rep.) that Minimed infusion sets are able to be billed under Pharmacy Perscriptions instead of DME, but I haven’t checked it out yet.

My pods as well as my Dexcom sensors are paid as “MEDICAL/SURGICAL SUPPLIES” by my Aetna plan.