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Tag: diabetic supplies

Time To Re-Order Supplies ASAP

Chris Stocker 2 Comments

I contacted my endocrinologist today because I need a new prescription for my pump supplies before I see her later this morning.  I was hoping that I could just wait until I saw her on March 25 to get a prescription from her, but there is no way that I am going to have enough supplies until that time.  I only have four infusion sets left and about 7-8 reservoirs.  The reservoirs, I don’t really care too much about because I re-use them a couple times before I actually throw them away.  Infusion sets obviously can’t be re-used.  I have been keeping one set in for on average about 6 days, and that is not the best idea either.

I am also getting low on testing strips so I am going to get a prescription for that also.  I believe that I am going to stick with using my Freestyle Lite meter just because it is the one that I am the most comfortable with and have used for the longest time.  I don’t know if she will write the ‘script out until I actually see her, but I’m hoping that she will, she’s really nice, so I’m sure there is no reason why she won’t.

I have been out of sensors for a long time because the ones that I have expired in October or November, I’m not sure of the exact date, but I know that I shouldn’t be using them.  Thanks to a fellow d-blogger, not sure if you want to stay private or not, so I won’t mention your name unless you give the ok, was nice enough to lend me a few sensors until my insurance coverage gets a little better and I can start getting them on my own.  Now I just have to re-charge my transmitter because I haven’t used it in so long, not since October.  I am going to try and start using them on Wednesday, so I can get 2 full weeks worth of data for my doctor’s visit.

I hate being this low on supplies, but it is part of life.  I can get them, I just didn’t know the process of getting them and just became ignorant to that fact and haven’t taken initiative until recently to make a few phone calls to figure out what I was supposed to do.  Well, time to wait on the e-mail notification on whether or not I am going to get my scripts today or not.

Have a wonderful day everybody.

Fired Up Friday – Diabetic Supplies vs Durable Medical Equipment

Chris Stocker 9 Comments

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.