Insurance


(ajax) #1

Ello!

Both me and my mom agree that I should get a pump ASAP, but my mom is concerned about money. I know pump companies will work with your insurance, but I assume i'll end up paying something out of pocket. I was wondering how much that was for any of you... I'm sure it varies hugely with different inurance companies, but it would give me something to tell my mom...

 

I'm also curious about monthly costs - i assume insertion sets are more expensive than syringes, and i'll probably be using about the same amount of insulin, except it will all be humalog, instead of half lantus. I'm just trying to prepare my mom for the bills...


(Joshy84) #2

This does vary greatly on insurance companies. My first pump I got I had to pay about 1,000 dollars out of pocket. Which minimed let us make payments on. The second one I only had to pay about 125 dollars out of pocket but that was afte rgetting the credit for trading in my old pump. As far as monthly cost goes if you get your supplies through medtronics or where ever decide to get your pump, They send them in three months supplys incremints. Which I know with my stuff from minimed they send me a bill later and then we pay it. I think I pay like 75 dollars for three months worth of supplies.


(kbuckleync) #3

My insurance company (Aetna) covers 100% of the pump costs.  They consider it 'durable medical equipment' instead of prescriptions.  So it actually costs me less money than if i were still on shots, since my durable medical equipment is covered at 100%.  I'm on the OmniPod pump.  

I'd suggest figuring out which pump you want and then having your mom call the company's insurance rep.  They can usually deal directly with your health insurance company to figure out what the out of pocket cost, if any, there is for you.  Might as well have them do all the legwork....save you and your mom lots of time!

And if it ends up costing less, like mine did, then how could your mom say no?!  :o)  It'll be a win win situation.


(A-D) #4

Kristen,

I am jealous.  I am also on the pods and have Aetna - but it's a high deductible plan so the first 4500/year is out of pocket and then they pay at 95%...  Between the pump, the CGMS, test strips and insulin, doctors appointments and two boys... they still cover quite a bit but... 100%?!?!?!?  That is AWESOME - I'd love to hear more folks getting that kind of coverage!

Cheers!

A-D


(Brittany) #5

My insurance also covers 100% of the pump coverages. Everything is paid for. The cartridges, infusion sets, insulin you name it's paid for by my insurance.


(BrianPQuinn) #6

Ajax,

As mentioned things for pumps vary based upon the insurance. For myself my insurance covered things 80/20 so I only had to cover the cost of the pump up to 20%. However, I also had a $1,000 max out of pocket expense for the year. So once I hit $1,000 i did not have to pay anything. I think typically though you should be expecting to pay about $700 - $1200 based upon what pump you go with. The infusion sets for a month with the cartridges cost about $160. That would be at full cost, but if your insurance pays for it you should expect something much less. When I got them in three month increments it cost me about $90 out of pocket. Hope it helps. The best thing to do though is to have your mom call your insurance company as each company is different.


(Gina) #7

[quote user="A-D"]

Kristen,

I am jealous.  I am also on the pods and have Aetna - but it's a high deductible plan so the first 4500/year is out of pocket and then they pay at 95%...  Between the pump, the CGMS, test strips and insulin, doctors appointments and two boys... they still cover quite a bit but... 100%?!?!?!?  That is AWESOME - I'd love to hear more folks getting that kind of coverage!

Cheers!

A-D

[/quote]

I also have Aetna, the only thing I pay is the co-pay of $25 but everything else was covered at 100% even my CGM supplies