Bab's Blog

It's just me, in words.

We don’t need insurance reform. . .????? August 2, 2010

Filed under: Uncategorized — babscampbell @ 9:49 pm

I have had the most frustrating afternoon. And, I’m one of the lucky ones.  I HAVE insurance.

In April of this year, I started using an insulin pump.  My Dr. gave me information about insulin pumps.  I filled out some paperwork and the rep contacted my insurance and before I knew it, I had a new pink Animas Ping pump hanging on my waist band.  At the time, I was told that I had to meet my deductible and pay my 20% copay and before I knew it, I’d already met my annual out-of-pocket maximum, so all durable medical equipment going forward would be covered 100%.

That was then, this is now. . .

I need to reorder my infusion sets and cartridges, and a new battery cover.  I called Animas (who, btw, is FANTASTIC to work with!)  had everything arranged, but I was concerned the insurance company may only let me order 1 month at a time, rather than 3 months, as I did in April.  The Animas rep suggested I contact my insurance company to verify my coverage.

I called BCBSof KC thinking they’d say, oh, go ahead and reorder what you received before.  I’m now told that Animas is not an in-network provider so my copay is going to be 40% and I have another $800 before my out-of-pocket max is met for non-network providers.  In others words, I thought I’d be getting my supplies for free, but, in fact I’ll be paying several hundred dollars.  Not only that. . .they now want to re-evaluate my April claim as it was probably mis-calculated and I’ll now owe 40%, plus what they paid from my out-of-pocket maximum being met.  OMG!  That’s what I get for trying to stay on my insurance’s plan.

I was then told that I need to go to the BCBSof KC website to determine an in-network provider.  THEN, I will be fully covered and my supplies will be paid 100%.  So, I look and there are several companies listed that are in-network, however, I only have contact information; name, address, phone number, website.  This means I’ll get to call each and every one of these providers until I locate the FEW that carry Animas Ping supplies, setup a new account, get a new prescription from my Dr. and wait for them to verify my insurance.  At this point, I was so angry, I was in tears. . .yes, BCBSofKC made me cry!

The BCBS of KC Rep finally offered to find a DME vendor that carries the supplies I need and after waiting on hold for several minutes, she came back on the line with the companies contact information.

So, here’s the kicker. .

Here is the pricing difference:

Animas:  Cartridges $36/10, Infusion Sets $135/10, Battery Cap $12

EdgePark Medical:  Cartridges $86/10, Infusion Sets $383/10, Battery Cap $43

Am I the only one that thinks this is ridiculous?  The insurance company will pay 100% if I use a middle-man company that charges 3X as much, but only 60% if I go directly to the lower-priced manufacturer.

And remember, I’m one of the LUCKY ones.  I HAVE medical insurance. . .

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2 Responses to “We don’t need insurance reform. . .?????”

  1. Linda Allison Says:

    I had a similar experience trying to get a Medtronic pump. I did not like the pump because I could not handle the tubing hanging down all over (I am a short person with a short trunk. I range from an A1C of 5.8 to 6.1. I use Novolog flex pens and Lantus pens. I looked at the cost difference and benefits. I could not see much advantage to the pump. I have a very small budget and income. Basically, the medical profession is a huge profit making industry. They encourage people to go for the most expensive things because they make more profit off of giving you those prescriptions. Just remember your doctor might be going to Hawaii because you and other patients are buying the products that he is promoting. He is getting some benefits from the Medical supply industry. They are partners in picking our wallets. I have turned into a person that has come to question lots of medical practices. I have toa sk “What is this procedure or suggestion going to benefit-me or someone in the Medical Industry?” I encourage all Diabetics to raise an eyebrow and ask lots of questions. If you are uncomfortable with a doctor-seek several opinions. -Linda A.

    • babscampbell Says:

      I’d like to clarify that I’m, finally, not questioning my Dr. here, rather the insurance company. My Endo suggested the pump for me and it has been the most wonderful change in my diabetes self-management. Prior to being on the pump, I was experiencing WAY too many lows and crashing overnight. The pump has really helped me stabilize my BG readings and achieve much better control.

      The question for the insurance company is: why would you insist I obtain supplies from a company that charges 3X more, when I could purchase from the manuafacturer for so much less? I’m sure once they reduce the charged amount by the “allowable” charges, it’s all about the same. . but then, why

      I ABSOLUTLEY agree with you though. . we need to truly “Self-Manage” our diabetes, research all options and work with our medical providers to find the best solution for our own treatment. I will never again blindly take the advice of anyone. Fortunately, my fantastic new medical team believes that I am the best judge of my treatment and I know more about my body than anyone else. They consult, educate, and leave the decisions to me. Thank you Cray Diabetes Center! AND. . thanks Linda A. for your comments. I hope to finally meet you this week!


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