I’ve been sitting on this post for a few weeks now. My friends know the story already, however even as I write this story is not even close to being done or solved yet.
I love having health insurance, I can’t say I love my insurance company, however I usually have no issues with them. Keyword being usually. Recently things have changed in my love for them and well now we are staring at frustration. This story starts back in November when I was getting things ready for replacing my Dexcom. Anyway, part of the process with my medical device company is that they call and verify benefits with my insurance provider. The call I get back is that everything is covered at 100% for both the system and also the sensors. WHICH IS GREAT. So when the time comes we order the system and a box of sensors, so that in December I can get a 3 month supply and be set for some time.
This is where the story goes awry. Near the end of December I see both the EOB from the insurance company and also the bill from the DME provider. Low and behold the invoice states that I owe around $400 for the CGM and also for the sensors. I didn’t do anything about it originally because I was busy and frankly this is what happened last year to me. Yet mid-month as I am getting ready to pay the bill I decide to call the DME company and talk about the bill. Mind you it wasn’t a complaint. Basically I told the person I was talking to the story and how while I am not happy about the bill the company should be on top of what they tell they people owe. $400 isn’t gonna break me, but if I don’t have to spend it, I’d rather not.
The DME company representative told me that their records show the 100% coverage and I should call my insurance company. So I call them. This conversation leads to the revelation that things are covered at 100% but any DME over $500 needs approval. The phone representative from the insurance company told me that if the DME company did call and get this done I should file and appeal. She gave me all the information I needed for that.
I call the DME company back and spoke with Jeff this time. I asked him to make a note in my file to get approval so I do not get billed since everything is at 100%, Jeff looks at my file and says “We called on November 9 and spoke with Mary and were told everything is at 100%, would you like me to file an appeal on your behalf?” YES! So he filed an appeal, gave me the reference number to that phone call for my own appeal letter and I was ready to move on with the world. Or so I thought.
Last week I get an EOB from my insurance company, the pump supplies that I was billed for in May should have been covered at the full amount and not the percentage that it was covered in…. So they reimbursed the insurance company for the full amount of the order instead of what they originally paid. SERIOUSLY?!?!?
So Thursday I called the insurance company to check that they did get my appeal letter, but also to verify insurance benefits because now I am intrigued. Surprise, surprise, my pump supplies should have been covered at 100% but because the DME was over the $500 threshold the supplies were billed as an out of network provider and not an in network provider. What does that mean? I paid almost $1000 out of pocket for my pump supplies this past year which I should not have had to pay. So when I get back from my vacation I get to call Animas and start this process all over again.
I am not a happy person right now. I am partially to blame because I did not follow up on knowing my full benefit coverage. However, I am more annoyed with both the insurance company for its level of underhandedness in how things are handled especially since I know the pump company and the DME company called to verify benefits. That $500 threshold should be told to them and be more apparent.
On a happier note. I am away for the week and enjoying my escape so far. You” never figure out where I am!