I think perhaps I got a bad distributor. She was wrong about my deductible and said a week of pods was like 700…I see online they are like 350…so who knows, I’ll take up the battle again tomorrow.
Outrageous! PREPAY is for gas cards and cell phones for crying out loud! Thanks for helping me vent!
For the insurance plan (also PPO) that I had when I was diagnosed, my deductible was $2500. (This was some insurance for students that was pretty cheap, I would hope that your employer can offer better).
I did some tricky things to stretch out supplies, which included wearing infusion sets for 6 days and developing scar tissue 
I hope that you can find a solution to this! Definitely talk to your employer!
I am watching our insurance too. I am going to start using the omnipod in April. I am a little on edge, and worried about our insurance coverage too. I am interested in the cost of the pods. I think my cost is going to be more per box than what you are getting them for. What is the other supplier. Right now we have insurance coverage, but I am thinking when the new contract comes out they are going to not cover retired employees. Our plan cost keeps going up. Don’t get me wrong I am grateful for what I have. but I am looking for cost cutting and starting a medical flex account. I am thinking that once I know what my total expenices are the flex account will how me out with the worry.
I think you may be misinformed or misunderstanding. PPO are usually pretty good. It’s usually $350 deductible per year (off the top) for medical supplies. Then, something like 80% coverage for medical supplies after that.
If we’re talking hospital stays, etc, then I can see $3500 for the top deductible… but for supplies, I don’t think that’s accurate.
call them up and ask them to explain. Hopefully you’ll get someone on the line who knows what they’re talking about.
I have a PPO and I just paid my $350 deductible for a Dexcom. From this point forward, for the remainder of the year, my supplies are going to be 80% covered.
The ER visit I had the other day, however, I’m not looking forward to that bill.
Mine is $2500… no mistake, and we have no other plan options… we’re stuck with what we can get. It sucks, and unfortunately I think it’s fairly representative of a LOT of what employers are choosing to offer now.
Most places know how much the insurance will pay before they bill them. I paid out of pocket for my son’s foot doctor since what he’s having done counts as a “surgical procedure”.
They charged me $195.44 at the time of service and guess what… the EOB shows my portion as $195.44.
Dexcom and Animas will both investigate benefits before they ship you anything - if you have to pay them, they’ll charge you first.
That’s very different than how Minimed worked… they would ship me whatever I wanted, take their time billing insurance, it was often a while before I got my EOB, nevermind any actual BILL from them. In fact I’m sure I still owe them a $200 deductible from several years ago (2006?) but I never received anything asking me to pay it.
Sarah- exactly.
I had to pay my deductible out of pocket before Dex sent me anything.
Medtronic shipped me supplies and very rarely asked for a payment. I guess they have major trust in their consumers. I did enjoy their customer service when it came to ordering things. Their tech support had something to be desired, though. haha.
Not always… it really depend on the employer and what they want to offer. The only plan available to us has a $2500 deductible… it’s either go with that, or we’re uninsured. Once we pay the deductible everything is covered 100% (and we have a $5000 limit for the whole family, so once we collectively hit $5k then we’re “all” covered 100%). It was a shock for me, as I came from a plan with a $200 deductible and I really did think our new one was a typo.
Our co-pays are fairly high as well. $30 for a PCP, and $50 for a specialist. Our Rx co-pays are $10/35/55/25% depending on the drug. The $10 price is the “preferred” formulary price, it’s not generic, we don’t actually have generic coverage (so yay for walmart’s $4 generics). The 25% co-pay drugs all require special authorization (Symlin falls into this one). So I pay $10 for test strips, and $55 for insulin. I can’t get Symlin until I’ve tried Metformin and my Dr says I have to try Symlin. It’s retarded. My total RX bill for the month is about $100.
Anyways, the whole deductible thing is really sucky considering pump and CGM supplies… it is basically prohibitively expensive.
wow. I guess I didnt’ know that it was based off of company coverage offering. I kind of thought it was the insurance company who set the deductibles. That sucks! I’m sorry!
Mine is $25 each scrip of insulin per month, $50 test strips, $25 office visits, $50 specialist, 80% supplies, 80% hospital and ER after $1000 deductible. My Rx per month is about $200 now that I’m using Dexcom. Gets expensive, but I can’t imagine doing it out of pocket. I’m struggling enough as it is! And I’m not even using a pump!
I agree 
I think if anything it just shows that Animas and Dexcom are more on top of their game. I kind of like that. Claims show up within 48 hours when I order supplies. I remember with Minimed it was often weeks later.
I habitually check my EOB statments to make sure I’m not being overcharged (which has happened), and that every dime I pay goes towards my monster deductible.
I’ve actually had some billing issues with Animas and my insurance, but it doesn’t seem to be Animas’ fault. My insurance just doesn’t want to pay (in fact they denied my entire order of infusion sets in December, but paid for the cartridges) - Animas has said not to worry, they’ll sort it out with my insurance, and if there is a problem they’ll let me know. They’ve yet to bill me for my out of pocket portion of my pump as well… partially due to the billing issues with my insurance (which refused to pay for 5 infusion sets out of my first order). They say I don’t owe anything until they can provide me with a final balance. Weird, but as long as I don’t owe them money yet, I’m cool with that
Can you try to call them an make payment arrangements? Like having them pull a set amount out of each paycheck or something?
with my deductible and copays I have the company deduct $100 out of each pay ($200 a month) until all costs are covered. They get some money, I get my supplies. They set me up on a payment plan for 3 months, then I reevaluate how much I still owe and renegotiate the amount they take out- so they dont pull out too much (ha.haha)
I’m on an HMO (Aetna) through my husband’s company and all of my pump supplies are covered 100% under ‘durable medical’. The test strips, insulin, etc fall into the co-pay category.
Good luck with this. :-/
For all the bad things that people used to say about HMO’s; I miss mine. Everything was covered and never a worry 
thanks
its because I am “out of area” they are in CA and I am in CO LAME
I thought I’d just post it so anyone who wanted to could take a look…
6782-k_summary_402500_PPO_deductible_HSAoption_2009.pdf (39.6 KB)
yeah, the only issue is that I was not given an option. It’s Kaiser, so since I am out of state, I am only able to have this one PPO plan. They are speaking to their insurance broker on Monday and assure me they will make this right, so we shall see…
My son is 5 and has never had an illness, and my wife never goes to the doctor…it’s outrageous!!!
You’re on a HSA, that is a high deductible plan.
Looking at that attachment, you’re going to have to pay a $2500 individual deductible or $5000 for all 3 of you, you got a break there as it’s not $2500 x 3 =$7500 for your family deductible ie you & son meet your $2500 deductibles each, 2 x $2500=the $5000 family deductible, your wife wouldn’t have to meet her deductible, however she would have to meet her out of pocket expenses mentioned below unless of course the other 2 members max that out as well.
Once the deductible is met, then those % listed under that will kick in, they will stop accumulating at $10000 for all you or $5000 for your stuff, aka Out of Pocket. Your $2500 individual deductible should go towards your $5000 individual deductible, meaning it should apply $2500 to that $5000, but double check. **edit, I just re-read the notes at the bottom of your attachment. Your deductible does not go towards your out of pocket maximum, so you have $2500 deductible and then another $5000 before your carrier pays at 100%
An HSA should be transportable, meaning if you leave your job you take any funds in that account with you. It’s tax deferred and it accrues interest.
If you do have a FSA (Flexible Spending Account), find out how it works with an HSA, there are some restrictions on one with the other.
A regular, non HSA, PPO may be cheaper, but you’d have to figure out the monthly premiums, all copays and deductibles and compare the 2 plans in order to tell. It depends on what your carrier and employer offer.
Find out if your prescriptions carry over to your medical deductible or if you have a separate one for each. *13 makes it sound like they don’t carry over but I don’t know what MedImpact is.