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Reader Question - Can You Help?

Can you help?Hey guys - quick question from a reader about medical insurance and insulin pump coverage.  I've had limited experience with insurance switches while pumping, so I'm hoping a few of you guys can offer another perspective or two for this SUM reader, so she can make an educated decision (and move towards a successful pregnancy - yay!!) 

"I'm switching jobs soon and will also be switching insurance companies.  Does this mean that I will have to go through the approval process [for the pump] all over again or will my next insurance company support whatever supplies I am using at the time I start my policy with them?  I have never changed insurance companies while on the pump and I don't know what kinds of hassle that will bring?  If any?  If I do have to start all over with the new insurance company, should I just give up and stay on MDI's?  Or should I go ahead and get pregnant and if I get approved, then start pumping mid-pregnancy?"

If you've got some advice for this reader, please leave your comments below!   Thanks in advance for your help, guys!

Comments

Usually you are able to keep things which you are already approved for, but you will need to check with your plan administrator to know for sure.

Another thing to check on is to make sure your current provider of pumping supplies is on their provider list. You don't want to have to go thru the hassle of getting authorizations to new providers when you need to order supplies.

Talk with your pump manufacturer, they probably have a department that deals with insurance companies and will help you get started with the new company. Good luck!

Since I've been on the pump, I've switched companies twice, and didn't have any issues either time. When I called to re-order supplies once on the new plans, I just gave Animas my new insurance info, and they billed accordingly. I never had to get re-approved or anything. It seems that most people don't get a lot of hassle from insurance companies regarding pumps these days as long as you're T1, although I know there are exceptions. Chances are, you'll never notice a difference unless the specifics of your durable medical equipment benefits differ on the new plan.

When I switched, I made sure that the new plan covered the supplies, and to make sure I knew how to order. One plan went through a third party supplies company, the other I could order directly from Animas.

It might help to find out if they will cover pumps for future planning when you need a replacement. One plan I had covered new pumps but not replacements, though I was able to get around that because my previous pump had been ordered on my previous plan & from a different company, since I also switched from Minimed to Animas.

I just switched insurance and didn't have any problems myself. If there were any issues that came up, I believe Animas handled them all. It could differ by insurance company, of course.

As others have said, the people to talk to will be your pump manufacturer. They'll have experience in this and should be able to tell you if there's anyone else you should be talking to. They may even have experience working with your new insurance company.

Good luck!

I just switched insurance companies with a new job about 2 months ago. I called the pump company with all my new information as soon as I had it. There were 2 shipments that were billed to my old insurance company (and denied of course) so I actually have to call to make sure the new company is billed for those instead. But this may have happened because of timing. I've heard that it's easier to get supplies covered once you're already using the device. I would call both the pump company & new insurance company to cover all basis and you'll hopefully not get any surprises. Good luck!

I have switched insurance companies several times during the last 12 years of pumping and have not had a problem with coverage. Benefits may be a little different resulting in a higher (or lower, yeah right) copay/deductible. Medtronic handled all of these changes for me once I gave them updated information.

Wow! Thanks Kerri, that was quick! You're awesome!

Just so everyone knows, I'm T1 and I've already been denied for the pump twice in 8 months. It's been several months in the appeals process and we are starting our next appeal now. I have reason to believe it will (finally) get approved this time. Just worried that right after I get approved, I'll switch insurance companies and have to go through this all over again! Not a fun thought!

I have been through a number of insurance changes since I started pumping 6 years ago / using a CGMS 3 years ago.

I found that once my previous insurance provided coverage for my pump / supplies, then the approval process with the new insurance was relatively quick and painless.

You should check to see how your insurance company categorizes pump supplies (as Durable Medical vs. Diabetes Supplies) because that may make a difference in your out of pocket costs. Also, check to see if your pump company is a contracted provider with your insurance, or if you should use a different medical supply company that is contracted with your insurance.

I hope this helps! Health insurance can be so complicated!

Layne -

Not sure what your insurance appeals process is like, but if you do get denied again and wind up having to get approval through your state's dept. of banking and insurance, then the approval will probably be valid no matter what your insurance is.

I was denied 2 times by insurance for a CGMS, but the NJ Dept. of Insurance said my insurance had to cover the CGMS, and when I switched insurance companies, that decision carried over.

Depending on the insurance carrier, you might have to get approved again. Call and talk to the broker who helps the company with the insurance. They can streamline the process and help you with it. I know because not only am a type 1 diabetic, but I am an insurance broker so I help with this stuff all the time.

I switched insurance a couple of years ago and had no issues. I called Medtronic and they handled all the changes. Good luck with everything I hope you get your pump!

I will be moving to another state after being in CA for over 30 years. I'm not alone but I will have to find a job and basically start all over again. I'm concerned about what happens to my pump? Can I continue to keep it? I've had it for over a year now and can't imagine life without it. It could be life threatening to me. What can I do? I'm really scared about losing the pump, I will have to struggle with buying the supplies but I think I can manage that until I get another job.

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