Insurance coverage for switch away from pump still under warranty?


(Thomas) #1

Hello everyone!

TLDR:
I am looking for some advice on how to best navigate switching insulin pumps when my current pump is still under warranty. I got my current pump ~1 year ago but have since switched insurance companies, and and wondering if my new insurance company is likely to cover a new pump if my current pump is still under warranty and if so, how I should best go about initiating this conversation.

Long version:
Here is my situation: I upgraded to the Medtronic 670G in January of 2018. My BG’s are better than the have ever been, but I passionately hate the 670G: it wakes me up constantly, medtronic customer service is terrible, the sensor is inaccurate, the list of reasons goes on and on. I decided soon after starting on the 670G that I would only stay on this pump until a comparable HCL system becomes available, which appears to be possibly happening in mid-2019 with Tandem’s HCL system. I have a new insurance company as of Jan 2019, and would like to start looking into whether I can proceed with switching to Tandem, but I am unsure about how best to go about getting the ball rolling. My understanding is that most insurance companies will cover a switch if your current pump is out of warranty, but how is that influenced by the fact that I now have a new insurance company that doesn’t know how long I have had my current pump? My inclination is to let my insurance company know as little as possible about my current pump, but I am not sure if that is possible. Any advice on how I should go about starting this conversation? Should I start the conversation with Tandem first, or should I start the conversation with someone else? My Endocrinologist didn’t have any very helpful advice - he said that in his experience some companies will cover a switch like the one that am contemplating and others just won’t. Does anyone have experience trying to execute a switch in a similar situation?

Thank you!


(steve) #2

I’d like to preface that everyone’s insurance coverage is different, so best to speak directly to TSlim if that’s your interest and your insurer. I have found in my son’s case, that our insurer won’t cover alternatives while equipment is still under warranty. Each supplier has their own rules, some may give you an out of pocket deal on switching to their unit others will not. I’d try to exhaust addressing your current unit’s performance issues with the company’s tech department if you haven’t already. Maybe there are some fixes to your issue. Otherwise, you can try to press for a return and refund, then coordinate with your insurer to start over. The latter is a battle, so you’ll have to navigate Medtronic’s internal resolution structure and figure out how to get to the right people, and around the front line of customer service that will tell you no. Still may not be able to, but you want to try and get as high up as possible to find that out.


(Charles) #3

Thomas,

The challenge is your doctor’s order is going to ID you as a current pump user. Tandem will also ask if you are a current pump user and the purchase date. The BIGGEST give away is your supply order paid by the insurance carrier. If you have refilled your supplies, you may be under water.

The most successful approach I have seen is to work with your doctor, explaining your challenges with the current device, and your desire to transition to another pump. Go off the pump for 1-2 months, to protect your doctor’s liability. Start process for the new pump.


(mikefarley) #4

Tandem may still be offering a plan where you can pay $1000 and get what is essentially a loaner pump for the life of your current pump’s warranty. Supplies would still have to be worked out with your insurance company. I assume you can find details on Tandem’s web site.


(Thomas) #5

Thanks for the comments everyone - your comments are echoing what I had been assuming would be the case: that the possibility of going through with a switch like this will largely depend on the specific preferences of my insurance company.

Unfortunately Medtronic has been very very slow at responding to concerns about pump performance (on my end and those of others - see the closed loop and medtronic threads here on T1Dnation), and apart from aberrant alarms my biggest gripe with the 670G is the inaccuracy of the sensor, which is not necessarily a problem as much as it is just the nature of the system. In other words, my issue is less of a pump malfunction as it is a massive disappointment with the pump’s performance.

Thankfully my Endocrinologist and I have a good relationship and he is on board with me doing what is best for me, but he couldn’t really offer any help other than wishing me good luck with my insurance company.

I hadn’t considered trying to get a refund on my Medtronic pump and then starting over, sounds like that would be a huge hassle but potentially a viable route forward if everything else fails.

It’s great to know that the biggest giveaway to the insurer is re-ordering supplies. I was able to sneak in another order of medtronic supplies before my old insurance coverage ended in Dec 2018, so I have a few months here before my intentions are revealed through that route.

Again, thanks for the comments and advice! I’m going to start some conversations with Tandem and see how things go. I will update you all here if I learn any lessons!


(ksannie) #6

I would never use a Medtronic pump myself, as I hated the one I had from 2007-2011, and I was allergic to their glucose sensors, which only last 3 days and were not accurate the first 24 hours anyway. I have used a t:Slim for a number of years now. So I am biased, and cannot speak to the insurance. I used to work for UHC, and they started only covering a single type of pump just as I was retiring. This is completely wrong. It is like having a National Health Insurance plan without actually having one, where you get no choice. They made a deal with Medtronic to save themselves money. But, just as with their preferred insulin, the savings were not passed on to the patients.

I do wonder whether you can turn off the notifications at night that are keeping you awake. I use a Dexcom, and the notifications for a high BG are quieter - I can set it to vibrate - and do not wake me up. but if I go below 55, the Dexcom first vibrates, and if I do not respond, it squawks loudly, which is important, as I NEED to be woken up if that happens. I am rarely woken up by my Dexcom. I can keep my sugars high enough to avoid dangerous lows at night. It might be cheaper to disable the glucose sensors from Medtronic and see if your new insurance company would pay for the Dexcom instead. They are accurate, providing you do not put the sensors into scar tissue. They are accurate enough to not need blood test strips.


(Charles) #7

Thomas,

You can find the challenges I have experienced with Minimed on the board. It has been tough witnessing the changes in customer service from the fantastic service company I experienced in the 1990’s.

To resolve my most recent issue, I had to go old school and write a letter on something called “paper” and do something called “mail it” to Medtronic. However, I got a call from Executive Customer Resolution to address my issue. It was not the outcome I wanted, but at least I spoke to someone with empathy and that made an attempt to solve my problem.

To get there you need to write:

Mr Hooman Hakami

18000 Devonshire St

Northridge, CA 91325

Hooman (Pres Medtronic Diabetes) is an ex-GE Healthcare guy, so is very good at following process. He handed off my letter to the Exec Resolution Team.

Good luck! Keep us informed how your communication terms out.