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Why do we have to fight/advocate with the health insurance’s customer service to make sure our kids with type 1 diabetes are covered?
Why do we have to live in “constant fear” that one day our child’s supplies are no longer going to be covered? And we would have to pay an exorbitant amount of money, just so he/she has a good quality of life with his/her Diabetes and have their much-needed diabetes products?
Click here, to skip to read our story first on what happened to us with our health insurance.
If you have these fears, then keep on reading for some tips on what to do on how to save some money on your child’s diabetic medical supplies, when it should be covered under your health insurance.
Here Are Some Tips When Dealing With Your Health Insurance Coverage
Know All Your Benefits
Knowing all of the benefits and coverage that your health insurance gives you and your family in regards to:
- Emergency Room visits
- Urgent Care visits
- Durable Medical Equipment
This should be one of the FIRST steps you should do, every time you sign up with a new health insurance, especially once your child is diagnosed with Diabetes.
Knowing your benefits beforehand will save you a lot of money AND headaches!
Dexcom and insulin pump supplies are usually covered either under Pharmacy or Durable Medical Equipment. Find out with your health insurance, which one covers it and how much its covered. It can range from 80% coverage to 100% coverage.
Try Dexcom Restarts (if possible)
If your child uses the continuous glucose monitor (CGM) Dexcom G6 can try to see if you can start to stack up on them, if possible.
I know the Dexcom G6 is hard to restart 🙄, I have NEVER been successful at this, but there are some people that have been successful at it. There are numerous tricks on these restarts. I suggest asking in a Facebook group or doing a search in a group, in regards to this.
Have a Backup Plan
If your health insurance is giving you issues, while you solve it, visit places like the Diabetic Warehouse, where you can get affordable diabetic supplies up to 60% below retail prices. They have a 3-5 day shipping, and if the order is placed before 3pm/EST, it will go out the same day!
Bulk up if possible on:
You never know if one day, something similar to what happened to me, could happen to you.
Go into Facebook Groups, where you can swap for medical supplies and only pay for the shipping.
One thing you need to be aware of is scammers. They are everywhere. Follow your gut on this one, if someone says something too good to be true,
The Endocrinologist’s Office
Talk to your Endocrinologist about your problem with your health insurance. Sometimes they have some supplies leftover or trials and can assist you in getting something to get by will you work with your insurance.
Google Is Your Friend
Do an online search for the phrase “diabetic supplies assistance programs in [state/town/country you live in]“. A list of places and programs will appear.
Also depending on your pump go into their Financial Assistance Programs.
The only one that seemed to not have an actual page for a financial assistance program was the Tandem TSlim, However, I suggest you contact them on their Contact page and inquire about this directly with them.
Our Story with our Health Insurance
I tell you, the month of March 2021, was H-E-L-L for me. Sorry if saying that word offends you, but it’s how I felt in regards to my health insurance.
So, let’s start from the beginning, shall we?
In December 2020, I noticed that my daughter’s Dexcom and insulin pump supplies were not covered with my current health insurance plan.
Weird because NOTHING has changed, only a new member ID number
I never received anything via snail mail about any changes of coverage or issues with my health insurance, which I pay a pretty penny every month.
At times, it has happened in the past where the system does not take the code correctly, or the person working in the claim inputs an erroneous code and it shows as not covered. I would then need to call the Customer Representative and have them manually reprocess it and done.
Problem solved. or so I thought this time.
So, every few weeks, I kept checking, and the issue of the non-coverage was still there from my health insurance’s end.
I ended up calling my health insurance 7 times before this was resolved!!
My daughter’s next refill was supposed to be sent towards the end of February. When 3 weeks passed, and I did not receive her supplies, this is where the 7th call came into play.
On this 7th call I learned that my health insurance STILL had not resolved the coverage issue and in order for us to get my daughter’s medical supplies, we had to pay out-of-pocket $4k+!!
I literally lost it!
I was fuming!! 😠
At the end of the day, I had to have a conference call with my health insurance and my medical supplies company at the same time. I was told that there was a ‘glitch” from my health insurance’s end.
We were able to get full coverage for our daughter’s Dexcom and insulin pump supplies. Just like it has always been since she was diagnosed at 15 months.
With every bad experience, comes some learning.
I hope some of these ideas help you out.
The best thing that we can do for our little ones is by being a very vocal advocate for them as much as we can, until a cure, or more affordable prices are made into law, at least here in the USA.
If I was not on top of this since the beginning, and known my benefits, I would have had to pay out-of-pocket the $4k for Amanda’s medical supplies, and that is simply not right, especially when she was covered since the beginning of this ordeal.