Just wondering what others have experienced with Diabetes supplies/equipment and insurance companies in the United States. Our Endo wrote prescriptions for strips, lancets, and pen needles. These items we can order once a month and they are free. Our Endo also wrote a prescription for the One Touch Ultra meter and Delica lancing device. Just wondering how often these can be replaced if lost or damaged or are we responsible for replacing after the initial issuance. Does everyone buy alcohol swabs or can the Endo include these as well as a prescription? For the pumpers out there how often can you get a new pump/parts and what supplies are covered by insurance? I know everyone has different insurance coverage and answers will vary. Just trying to get an overall understanding of how the process works.
United Health Care will allow me insulin pump replacement every 3 years I believe. My pump is 4&1/2 years old still doing good. CGMS also the same, replacement every 3 years. You have to submit paperwork for approval each time. Co-payments vary as per your individual insurance companies guidelines I believe. Infusion sets, sensors also covered again with your out of pocket depending on your insurance guidelines - mine is 20% of approved amounts on pump supplies and I now have to order sensors under my prescription drug plan (company policy) and pay $60 per box of 4. I have no coverage for alcohol wipes, additional tapes, any form of skin tac (protective skin wipes/adhesive). That is all out of pocket for me. I believe most pump manufactures warrenty for 3 years - assuming it is a breakdown of the pump not due to mis-use (such as falling into the swimming pool). Strips and lancets are covered under prescription drug so I have a co-payment on those. I have not had to replace any glucometer in years, I have 3 that I use regularly. In the past, I have been able to replace old glucometers by working with the company directly and get new ones free. I don't know if that service is still available today.
My experience has really varied over the years depending on what insurance I had. I currently have Blue Cross/Blue Shield and it has been fantastic. I pay about $200 every three months for enough test strips that enable me to test 10x/day. I pay about $90 every three months for my Humalog insulin. I also periodically get pens and pen needles and these are covered by my insurance. I have never gotten alcohol swabs via prescription, but they may be available via an Rx. I have never asked. Lancets I usually buy out-of-pocket because they are so cheap and I just don't buy them often enough to really make a difference (I think I'm still on the same box that I bought in like 2004...and I am not kidding!)
Pumps get a little more complicated and expensive. For the pump itself, my insurance covered most of the cost (I think 80% or so) and I picked up the rest (about $900....the pump I use, a Minimed Revel, runs about $8,000). You can usually upgrade to a new model for a fee after 3-4 years, and I believe insurance covers a new pump every 5 years. The supplies run about $50/month out-of-pocket for me, but I'm not positive on that. But, the good thing is that when you get a pump, you get to cover all ancillary supplies under it and those are billed to your insurance. So, if you need things like SkinTac, prep pads, etc, all that stuff is covered under your insurance automatically, and you just pick up the co-pay.
All "pump parts" (like a battery cap or something) are covered under the pump's warranty and get replaced free of charge if damaged. If the pump stops working for some reason, they will send you a new one. My current pump has been very durable and has thus far withstood more than a year of abuse.
I have a Rx for all of my medical needs and my Insurance co. pays for most of it, I also have a flexible spending account and use it to buy things like tape, neosporin , hypafix, and pay copay cost. Most insurance co. will pay for a new pump every 4 years and medicare is every 5 for most people. Meter company's will give you a new meter anytime you feel like there is something wrong with the one you have. Me and my insurance co. has spent enough money on test strips to buy a nice house it's only right for them to supply me a new meter from time to time.
Great insight thanks so much for responding !
Thanks so much for your comments. This info really helps!
Thanks for the flex account idea … I’ll have to check it out.
As you said insurance companies vary. My insurance company recently sent me a brand new meter complete with 10 test strips and required that I use that brand of meter or they would not pay. Some insurance companies get in bed with strip companies etc and get a good deal on specific meters, pumps, syringes, insulins, pens and pen needles. You need to research what your specific company will and will not cover. In general most insurance companies will cover the basics, test strips, insulin, etc most have a co-pay, some will allow you to purchase all your diabetic stuff via mail order in which case you need the endo to write a script for the 90 days worth of stuff and make it refillable 3 times. There has been a thread here about how often do you change your lancet and the vast majority of us don't change it often enough to really require more than the original prescription. As bustedpancreas said, most still have leftovers from the first time we got a lancet device. The delica one is a bit more "flimsy" i.e. I don't think the lancets will last very long so you may need to replace more often. I still use the one that came with my OneTouch meter and probably have the 10 freebies that came with it as well.
As others have said, be sure to check the specifics with your insurance company. The coverage definitely varies between plans so look at those costs closely between plans if your employer gives you a choice.
Be sure to call the insurance company and specifically ask if there are any special programs for diabetes supplies - my plan has such a program and I didn't know about it for many months (and all the while I was paying out of pocket costs higher than I needed to).
My coverage is through my employer and it's a BC/BS plan. As part of my plan, BC/BS has a contract with a 3rd party provider for supplies. I receive a 3 month supply of test strips, alcohol wipes and lancets every 3 months at no out of pocket cost to me.
My Dexcom sensors and my OmniPod pods come every 3 months at no out of pocket cost to me through a 3rd party supplier authorized by BC/BS. The only cost I incur was $190 for my OmniPod PDM and $15 per month for 2 vials of Humalog.
I hope my plan doesn't change anytiime soon because this is the best coverage I've ever had as far as diabetes cost.
I have Kaiser Permanente insurance in California.
My Endo orders the stuff for me and it just shows up at my door every 3 months.
I changed it to have my sensors sent when I request them because I found they were expiring too fast if I get them 3 months at a time.
I can get a new pump every 5 years and a new CGM every year if needed.
It is only 80% covered though.
I think my insurance co has a special arrangement because I also get a box of IV3000 and a box of ivprep wipes at no charge at each delivery.
I've never paid for a meter. You can usually get them free, the companies make their real money on the test strips. You can order a onetouch mini for free on-line at onetouch. But in most cases, if you just call customer service I bet they would send you a new one. Particularly if you discuss with them about how you are considering "other competing meters." Not sure about the delica, they might even throw it in. But the Delica is only $20 at CVS or other local stores, that is less than my co-pay, so I would just buy it. A lancing device lasts forever.
ps. Many endo's carry a stock of meters and lances with the sole purpose of giving them to patients. They are provided these meters and lances by sales representatives who wish to line up new customers for test strips.