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Medical Forum / Diseases and Disorders / Diabetes / August 2005Medtronic Minimed supplies as a perscription
Is anyone getting their Minimed supplies through a perscription? Minimed originally set this up to go direct to our insurance, which means it goes against the deductable. Our deductable has doubled, so insted of paying 100% out of pocket for 10 months, then 80/20 for 2, we are paying 100% for all 12 months. If we can purchase these supplies via perscription, then we have two different perscription plans that we can utilize for payment, depending on how we order. So is anyone getting these supplies through a pharmacy via perscription? If so, which pharmacy? Thanks; Edwin > Is anyone getting their Minimed supplies through a perscription? > [quoted text clipped - 14 lines] > > Edwin All pump supplies (well, infusion sets & reservoirs) require a prescription. Your doctor or nurse has to fax/mail a prescription every year to MiniMed in order for you to get your supplies. At least, that's the way they say it works. Most pharmacies don't carry pump supplies. I have seen some diabetes supply places online that list MiniMed products, and their list price is higher than MiniMed's retail price. I assume that MM doesn't give 3rd party sellers much/any discount. Even if your local pharmacy said they'd get the stuff for you, you still might have problems with insurance. Some insurance will list pump supplies as Durable Medical Equipment, and others might list it as Diabetes Supplies. They might have different rules for the two categories. I think for those who get their pump supplies as DME, they end up paying a lot more. I still don't know how my insurance categorizes pump supplies, but I do know they cover them 100%. They have negotiated a price with MiniMed, and that's what they pay. I get the EOBs (explaination of benefits) in the mail and it will show that MM billed $X, my insurance paid $Y, and they'll show the difference as a "discounted" amount and show my responsibilty as $0. My plan has no deductibles, just co-pays, but there are no co-pays associated with my supplies. I do have a $10 co-pay for all other diabetes scripts - insulin & test strips. -- Liz Okay, thanks. You are correct, the supllies are billed to me as DME and in my case go against my $750/yr deductable after which I pay 20%. We haven't had the Pump many years, and just got it paid off. Minimed just sent us the bill for the previous years balances that the insurance didn't pay which ends up being a lot. This is for supplies. The pump billing was handled differently than the supplies. Very confusing and frustrating. The place I work for just increased our premiums a lot, doubled the co-pays for many items, and double some of the deductables. It's to the point that our health coverage is costing much more than the benefits. But if you drop it, as diabetic, you are hosed. > Very confusing and frustrating. The place I work for just increased > our premiums a lot, doubled the co-pays for many items, and double some > of the deductables. It's to the point that our health coverage is > costing much more than the benefits. But if you drop it, as diabetic, > you are hosed. Don't forget, either, that even w/o diabetes, things happen -- cancer, falls down stairs, etc. and those can be very expensive. One year I had both rotator cuff surgery (+ rehab -- lots of p.t.) & cancer (surgery & treatment). Even w/o dm that was one expen$ive year! Made up for quite a lot of premiums. bj Yes, I agree. I don't have diabetes, it is a family member that does. We are paying over $6000 a year for our insurance, and getting much less than $6000 a year in benefits. Point being that I have no choice. I have to pay this, for the reasons you listed, for one. Also because I can't get insurance outside of work without paying a lot more due to the diabetes. And if I drop insurance, diabetes becomes a pre-existing condition. Without diabetes, I can easily find a plan outside of work that would make more sense. Myself, I am at a point where I don't use the insurance much at all. I have done the research and found major medical plans which would end up costing me less net per year, even though some specific things would cost a bit more. I would also have more choice as to where I go for treatment, which means I can shop around. I already know certain places that charge much less for office visits than where I currently *have* to go to be in network. Talking ~$60 versus $240 per visit (@40 copay) for the basic stuff. But I can't do that because the family member has diabetes. > Without diabetes, I can easily find a plan outside of work that would > make more sense. Myself, I am at a point where I don't use the > insurance much at all. And this can change in an instant. I paid in my insurance premiums for years & years & years, with little "payoff". Then I had orthopedic surgery & lots of p.t. Then I got diabetes. Then I had another ortho surgery & rehab. Then I got cancer. All that within 4 calendar years. *LOTS* of "payoff". I now get more "return on investment" than I used to, what with dm stuff, cancer checkups, etc. but on the whole I'd rather pay more & need less! I hope I don't have another year when I actually exceed the out-of-pocket limit (& no more %copays) -- that would mean I was Really Sick. bj >> Without diabetes, I can easily find a plan outside of work that would >> make more sense. Myself, I am at a point where I don't use the [quoted text clipped - 15 lines] > mean I was Really Sick. > bj When I first got insurance, thorugh work, I already had diabetes. The plan had a one year period where they would not cover pre-existing conditions. At the time, I hadn't been checking my BG and was taking just 2 shots a day (N/R in the morning, N at night). Since I knew I couldn't go to a doctor for at least a year I continued doing the same. Even after the year had passed I didn't think of going to a doctor, until my asthma flared up and I finally went. The doctor ordered an A1c, and the result was 15+! That insurance had no prescription coverage but I started buying test strips, got a script for Humalog and began injecting before all meals. A few years ago we got a second insurance option at work and I switched. It has prescription coverage, which makes being diabetic much more affordable (asthma as well, plus the other three drugs I'm currently taking). I pay half of the premium and my job pays half. So, I pay about $2,400/year for insurance and I use much, much more than that in services & meds. I just got my pump a few months ago, and that alone was thousands of dollars. I have no deductibles and the co-pays for doctor visits ($20) and prescriptions ($10 generic, $25 brand, $10 diabetes no matter what) are very reasonable. It also seems that I don't have to pay *anything* for my pump supplies. I never thought an HMO could make me so happy. It is much better than my previous PPO (POS?) plan which was the "premium" coverage we had with Oxford (and costs just as much as the HMO we have now). -- Liz > Is anyone getting their Minimed supplies through a perscription? Hi Edwin, I get my supplies directly from Minimed but they bill my insurance. It's covered under DME on my plan. I can't get the supplies from any other source. Local pharmacies don't carry them nor does my mail order pharmacy, which is where I get just about all my stuff. Good luck! Insurance in the country is definitely an "experience" ain't it? JJ It's defenatly a big consideration when looking for work. $6000 a year for poor insurance versus a lower paying job with better/less expensive insurance -- makes a big difference. While I can understand that the pump itself is a DME, I don't see how the supplies are considered DME. DME is equipment that: can be used over and over again; is ordinarily used for medical purposes; and is generally not useful to a person who isn't sick, injured or disabled Maybe we can reuse the pump supplies over and over again versus throwing them out as we currently do? Being sarcastic. They are single use items. The use time is just longer, as the insulin is injected slower. Gas price is up, food cost is up, insurance is up, benefits are down. I think it's just time to ask for a raise. |
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