I posted this as a blog, but I would really like some good advice so I posted it in here too.
For a lot time I think I was scared of pumping. Terrified, in fact. I made up excuses. “I don’t have time. I don’t have the money.” But now, I can say, that I am finally ready to get to pumpin’.
However, those issues still remain. Particularly the money issue. Sure, my insurance will cover part of the start up costs as well as some of the supplies. But I will be left covering around 1500-2500 dollars. Neither I nor my family has that kind of money. Not to mention the inevitable CGM (something I really, really want!).
How do I determine whether pumping/CGMs are things I need or simply want? And what about when my opinion differes from my insurance company?
And even worse, what about in 9-18 months when I will lose my parent’s insurance? Should I just stay on injections, since they’ll be cheaper when that happens???
I guess my real question is, does anybody know of any way I could get help funding my initial pump purchase? The insurance questions will be answered later I’m sure. But I don’t want to start getting ready for a pump and find out that I won’t be able to afford it.
When I got my first pump, My insurance company covered it except for about $1000. The manufacturer set up a payment plan, so I only had to pay a small amount each month for the pump. My insurance covered the most of the future supplies.
Hey Sarah:) I would advise having the pump company start the processing to find out just how much out of pocket you are looking at covering. On my first Minimed pump I paid $800 co-pay on the actual pump and $25/month for supplies…w/ Aetna I could not even get the pump…had a cap of $1000 on durable equipment. So…it really depends on your coverage and you never reallllly know how much coverage you have…until you ask for it;)
I think the pump is well worth it…despite its quirks and frustrating problems…and when I lost insurance coverage all together…I found a way to get supplies reasonably priced. If you want to know more…just email me. Lantus and fast acting is the only other option…it is more difficult and frustrating…cannot fine tune night time basal…I even tried adding an intermediate insulin! T1 should all have the option of using a pump.
Something to consider…given new innovations on the horizon…you may wish to find out how much of an investment you have to make and follow newer pumps (pump as you go) that are coming out soon. The Solo is one of them…they plan on eventually incorporating CGMS in the really small, tubeless pump. This would be something I would look at. So…even though I have insurance now…the copay is SO high that I am going to wait to switch out my pump until some of the others come online. When the Omnipod showed up on the market, they offered a trade w/ the outgoing Cozmo pump. Would love to swap my less than new MM for a new Solo+. So…I would try to get the current pump at a good price and then keep looking for the upgrades w/ CGMS…if you need fine tuning ask your doctor to order a 72 hr CGMS…insurance should pay for that completly (copay).
Well…just my ramblings and experiences:) Take it for what it is worth and explore all your options. Good luck to you and hope money and coverage are not the only things holding you back from trying the pump. Be well!
Yes, I am currently on lantus and fast acting (humalog). I am seeing the problems with not being able to fine tune, like “dawn phenomenon” morning highs, etc. I am ready for the pump. I am just nervous about the financial aspect. I am going to the endo on the 16th, and going to ask her more. I am hoping that the manufacturer of whatever company I choose will be able to set up a finance plan with me. I am going to go with a traditional pump vs the omnipod, because the long term costs will be cheaper I think, in case I lose insurance.
Also, let your potential pump company to get your benefit information from your insurance company; that way they can give you real numbers to work with. I know Animas offers a payment plan for pumps, and they also have contracted rates with some insurance companies. I have Keystone Health Plan East in Pennsylvania, and the cost of the Ping (retail) is $6345. However, it’s going to be $5000 flat with my insurance company. Covered at 90%, that knocked off over $100 from my out-of-pocket costs. They also have a contracted rate for supplies (insulin reservoirs and infusion sets).
On the other hand, if you’re looking into podding, like the OmniPod, the upfront cost is definitely cheaper (something like $1700 to start), but the monthly costs will be higher.
My pump would have cost me about the same if I bought it directly from the pump company (because it was out-of-network, I think). Check and make sure the reason for the cost. In the end, I bought my pump from an in-network third supplier and didn’t have to pay anything.
I think it would be best to get your pump while you have insurance and order as much supplies as your insurance allows.
Once you lose your insurance, will you transfer to another insurance?
There is also an organization that supports people who cannot afford an insulin pump: ipump.org
