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. . .