What to tell insurance when requesting a new pump

#1

My son’s Medtronic insulin pump is out of warranty so I called Tandem to order their new pump. The Tandem rep told me she needs to have a reason “*a malfunction or anything less than perfect on the pump. Malfunction examples: *battery charge isn’t lasting very long, *loose charging port, *buttons are sticking/not as responsive, ETC. to move forward with your account”

There isn’t anything wrong with his current pump. It’s just out of warranty and that should make us eligible for a new one.

Has anyone else been told to make up a reason they need a new pump? If so, what reason did you give? Is this true insurance won’t cover a new pump just because it’s out of warranty?

#2

I can not speak to the policies within the insurance company, and why they require the out of warranty pump to actually have something wrong with it. Every time I ordered a new pump it was the same routine. They will accept almost anything as an excuse to replace the pump though, I usually just tell them the screen isn’t as bright as it was. No one actually looks into the issue with the pump and a lot of times you don’t even need to return the old pump so you can keep it as a back up.

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#3

I’ve been using pumps for a long time. My experience with answering the insurance questions you describe is similar to what @Riley1 reports. They didn’t always ask these questions but I see this tactic as one to squeeze some more time out of an old pump.

The last time I received an insurance covered pump, I also told them that the screen was difficult to read due to the display dimming. This was true by the way. Every pump I’ve used for four years has had some kind of defect.

Medtronic pumps are susceptible to the case cracking, especially near the battery screw in cap. I suspect, if you use a bright light and maybe some magnification, you will see some hairline cracks. These cracks are enough reason for the insurance company to pay for a new pump.

You say that your son is wears the pump and I would be surprised I’d the case is still pristine.

Why should you depend on a medical item that even the manufacturer has withdrawn the warranty. This is not a simple consumer good whose continued performance is nice but not necessary. This pump is responsible for replicating the action of a failed pancreas.

#4

You can say you are getting a lot of “insulin flow blocked” messages. I get those once in a while on my fairly new Medtronic pump.

#5

My last pump was 3.5 years ago, and did not encounter this. Told endo pump was out of warranty, and his team + Medtronic rep made it happen. Who knows what they documented for insurance, it was not shared with me.

My next pump will likely be Tandem, with different insurance. Its likely to be a bit more involved on my part. So this information is good to know.

#6

They always told me to say, it’s old and scratched up. And that worked.

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#7

I changed my pump only about 4 months before the warranty ran out because the battery compartment had broken and it would run out of batteries every 3 days or sooner. When my warranty ran out, I told them the truth that when it got humid, the screen would black out. It was not really much of a problem because it doesn’t get too humid here, but they accepted that as a valid reason. Nobody has asked for the pump back, so I could have said anything really. It took 2 and a half months for me to receive the new pump, with constant calls to tandem, my doctor, and ccs medical. If the pump does break after the warranty has run out, you don’t want to have to wait 2 months to get a new one, so better to make something up and do it now so your son remains safe.

#8

My endo worked with the pump representative and wrote the script with reason for a new pump. Let them handle everything.

#9

Who is your insurer?

#10

Thank you for everyone’s advice. I really appreciate the ideas and input. I reported that the display screen is scratched. Now I wait for the endocrinologist to sign the paperwork and the insurance to approve it. (Fingers crossed)

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#11

I have always/only used Medtronic pumps. I started with the Paradigm x15 model, I think. In October of last year I started on the 670g. I had been using my 530 (?) pump that was out of warranty when it died suddenly and I had to go back to using my even older Revel. When I called Medtronic about getting a new pump I was surprised at all of the questions they asked about the current pump I was using. They said that insurance companies didn’t care if a pump was out of warranty if it was still working. My Revel was in pretty bad shape. There were cracks on 3 out of 4 corners of the screen and the case. There was a piece of plastic missing from around the battery cap area. And it was way out of warranty. The thing is I probably would have gone on using the 530 for years if it hadn’t died.

The Medtronic rep also had me search my alarm history for any no delivery or other non-standard alarms like low battery.