I have only been a type 1 since October. Lost a pregnancy 2 weeks after being diagnosed. Got my a1c down to 6.4 in January and was given the go to get pregnant. Endo and I think a pump and cgm will help with control.
So, I started on the 6 week free trial with the medtronic 530g and enlite sensors. Enlite sucks. Horrible. Frustrating. Hated them. Pump is fine though. Sooo I decided to start looking at other companies since I want to get the dexcom g5 anyway.
The local rep from Tandem calls me back and says itās only going to be $150 for the pump and $25 per month for supplies. I spoke with him again today and told him it sounds too good to be true. He says it is billed through my express scripts and would come from a medical supplier.
Had anyone else had this happen? I am still waiting for them to call me back to order the pump, but my doctor has already given them a prescription for it. I just donāt want to get my hopes up!
my sister have, it, & my mom,only had to pay, $160, for it, & the supplies, are $26 ever month, for supplies,.
but if, you want to know for sure, call them back to make sure, hope this helps,.
Welcome to TuD, @Dana925! Iām not a T-Slim user, but just FYI, I use a Medtronic Minimed and Dexcom G5āyou donāt have to use Enlights if you donāt care about integration with the pump, and I donāt, particularly since G5 Bluetooths to my iPhone, which I prefer anyway. But that T:slim cost does seem very reasonable.
And really sorry to hear about you losing your pregnancy just after being dx-ed. Either one would be bad enough on its own. But this is a very supportive placeāreally glad you found us!
For your sake I hope the info is correct. In Dec 2014 we paid a little over $1500 for the t:slim & 3 months supply of infusion sets & cartridges, & that was with deductible met.
I can pay $25/box of cartridges if I pay cash. Through my insurance, itās $36.45/box.
I am receiving mine tomorrow and it went through my prescription coverage. Since I have no
deductible, it was $45 for the pump and initial supplies and then $30 per 3 month supplies there after.
Thatās wonderful! They werenāt lying for me either! I ordered it last night and it should be her by the end of next week!!! It still seems too good to be true!
Well, clearly there is more going on under the covers here in terms of payment than what is currently being billed to you. I truly wonder what it might be.
I think it could be helpful if you could give more insight into what insurance coverage you have. Itās nice to know that others have had good fortune. It would be even nicer to know if anyone else might also be able to participate, no?
So when I asked the medical distribution company about how this is possible, she replied, because Tandem is smart. I laughed and said how so? She basically said they code their pumps, cartridges and infusion sets as medicine and dme. Like how syringes go through prescription coverage, that is how a pump is considered. So it can be covered either through prescription or medical insurance. I have express scripts though my husbandās work as prescription coverage .
I think this surely has something to do with which insurance you have.
I wonder if it might explain the trouble Iāve been having getting cartridges covered. Medical keeps denying payment, saying theyāre supposed to go through Rx. Rx says theyāre not a covered benefit. Iāve had to go through written appeal for every order Iāve placed. The last order in Dec was billed as home health. Insurance paid 100%, even though I paid Tandem the remaining deductible + coinsurance.
4 years ago, my Minimed pump was $40 copay, under my prescription plan. It really all depends on the how your insurance plans are set up. At that time, if I ordered my diabetes supply via mail order, 90 day supply all in one order (ādiabetic kitā rule), there was a single $40 co-pay. This included BG strips, pump supplies. Insulin pump, Dexcom Rcvr, Trans, Sensors were all covered under my prescription benefit, all with $40 copay. I know others that mentioned variations on "diabetic kitā pricing in their plans, sometimes relating to when insulin was purchased at the same time.
Unfortunately, my insurance plans have changed, and donāt offer that any more. It was my employer that changed the āplan optionsā they contracted for. So now I can only get the pump, CGMS and supplies under my Medical planās DME coverage. Now that my MM pump is out of warranty, my next pump will be 20% co-insurance (approx $1200-1500), since my deductible has already been met this year. It would be similar if I was choosing T-Slim.
I was considering the T-slim, but think I will stay with Minimed (and Dexcom CGMS as separate receiver). I was able to test out the T-slim menu/interface by downloading the app, and found it would be too cumbersome for me since I generally determine my bolus without using the wizard or entering BG/carbs, etc. I also prefer to have the CGMS receiver not be integrated with the pump. The T-slim with integrated CGMS was the only other option I considered.
Good luck to you. If the T-slim representative confirmed the benefit, specifically after contacting your insurance, then it should be accurate. You may find documentation in your health insurance plan that would show diabetes related ādurable equipmentā is covered under your Prescription plan. The amounts you listed sound like āco-payā amounts, rather than co-insurance. RX co-pays typically have a max amount, which may be the $150 you were quoted.
As far as I know It was billed under my prescription coverage. I am in NY where diabetes supplies are usually billed at the same rate as you would pay for a primary care visit. It is a special ādiabetesā prescription package. I was expecting it to be billed under DME and then I would have paid 10%. I have marketplace insurance on the NYS Health Exchange.
I donāt know how you managed that. I paid $1800 with a 50 percent DME and trade. The pump is listed for $7000 or soā¦There was not ever any offer to run it through in a different way. Too bad too, because this pump is not working for me at all.
My son had Medical Mutual in 2014 when he got his Tslim and didnāt pay anything out of pocket for his pump and all supplies. They have a disease management program. Then his employer changed to Aetna last year and now he has to pay for some, not sure how much. Itās not a huge amount though.
I also have Medical Mutual and just got a pump in November and didnāt pay anything out of pocket. Mineās a Minimed 523. My insurance uses CCS to supply my stuff. They have always been great to deal with.