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Fired Up Friday – Diabetic Supplies vs Durable Medical Equipment

I am sure you all know exactly what I am talking about just from reading the headline of the post.  If you don’t, then I will explain.  The insurance company looks at your different type of supplies in two main categories, prescription and durable medical equipment.  The way your insurance company defines them is most likely very similar, some minor differences I’m sure, but overall the same.  Now, what is the biggest difference to you?  Prescription is usually just a co-pay, for instance, $90 for a 90 day mail order supply.  Durable medical equipment (DME) products must be paid for with your deductible at first and then there is a yearly maximum that the insurance company will cover.

I’ll use my personal insurance numbers as examples for today because I don’t mind disclosing values.  I pay$115 a month for insurance through Cobra since I was fired back in November.  With that, I get my insulin which is a prescription, at $90 for a 90 day supply, which is about 16 vials of insulin.  My testing strips I get at the same rate, $90 for a 90 day supply.  I test about 10 times a day, so that’s 300 strips a month, so 6 boxes a month, which is an order of 18 boxes of strips for $90, can’t beat that. Now, the costly stuff comes in with the insulin pump supplies.  I have a $1,500 deductible, so I will have to pay $1,500 out of pocket before the insurance even begins to cover it.  This is about one 3 motnh supply worth of infusion sets and reservoirs, more on that later.  After that $1,500 is met, then insurance company covers only a maximum of $2,000 for the year, so they will cover only one more 90 day supply.  So that leaves me with 6 months to have to pay for infusion sets and reservoirs myself.

Here is where my problem with the insurance companies comes up.  Why do they consider my infusion sets durable medical equipment and not as a diabetic supply?  Diabetic supplies are covered by your prescription plan which would just be a $90 co-payment.  I understand that people use infusion sets for other things other than diabetes, but if I am using them to manage my diabetes, wouldn’t that be considered a diabetic supply?  This is just another way that the insurance companies can force you into paying extra money in order to survive.

Is there anything that we can do about this?  I really don’t think there is, but I wish that we could.  It is just irritating to know that this is a supply that I need to control my diabetes, so doesn’t that make it a diabetic supply?  Now, I don’t know if you all know how exactly products are billed to the insurance companies, but I will give a little advice on to how this is done.  Your supply company basically charges 3 times the amount of what you would pay to purchase it with cash online.  For instance, if you could buy directly from supplier at $100, they will bill the insurance company $300.  So that eats up your yearly maximum 3 times as fast.

First thing that I would suggest to you, is to find out the policy with your insurance company for reimbursement for submitting invoices.  Some insurance companies will allow you to purchase your insulin pump supplies in cash and then submit the invoice to them for payment.  This could save you a lot of money in the long term because you can get 3 times more in supplies.

Well, like always, I want to hear your feedback.  Leave a comment, hit me up on Twitter, e-mail me, do whatever you want, but I want to hear your opinions.