Approved

so...i called my insurance company today after not hearing for a good three weeks about the second claim request to have them approve the animas pump and cartiages for $6,995.00

The woman I spoke to on the phone said it had been updated the other day and that it has been approved but only for $6,600.00. Puts me on the line for $395.00 when I have $10 to my name, a maxed out credit card and a $200 phone bill due in a few weeks(as well as the costs of cleaning and moving at the end of the month and utilities). That wasn't so great..but at least a big chunk of it is approved.

I talked to my insurance rep at Animas and she's put in a price drop request from $395 to $95 to help me out, since my insurance company won't cover the whole thing. I'll find out in a few days if that'll happen.

 

 

....so looks like this is gonna happen...

 

I'm already scared about not doing needles anymore. I love my needles.

yay! I'm so happy for you! You will love the pump. And you still get stuck once every 3 days anyway :)

it's not the same. i was on the saline trial so i was still able to do my shots which was fine...now i won't be at all!

i honestly love my shots. i'm so used to them it's like breathing. i can wake up at 8am in the morning, half awake, take my shot without my eyes being fully open and go right back to sleep like it was nothing.

Congrats to you Batts. I hope it all goes well.

Now you can look forward to changing your pump site while half awake ;)

[quote user="Batts"]

I'm already scared about not doing needles anymore. I love my needles.

[/quote]

Then why are you doing it?  This question has perplexed me ever since the "batts is gettin' a pump" thing started.  If you don't want one, don't get it.  You're not a bad diabetic if you don't have a pump.  But, do what you want.

I'm doing it because my lifestyle is so crazy doing shots isn't really working and I can't get my A1C down. As much as I love them, I have to give the pump a shot to see if it'll help and make things easier. i am going to go back to my shots if it doesn't help my A1C.

i've got an anexity problem with giving up my needles because i'm so used to them..i can't remember when i didn't have to take them so it's kinda like a security blanket for me, which is why i'm scared about it. it's a huge change, but maybe it's going to be for the better. i think i just assumed and convinced myself it was never going to happen even though i've been talking about it. if my insurance wasn't going to cover it, i wasn't about to go out to the bank and get a loan for $7k to get one.

but i am excited about trying the pump now that i've talked to the rep about it and learnt more. i like the fact that i won't have to force myself to eat, my mom and i won't fight over me only eating two meals a day(on a good day, sometimes i have a small snack during the day and eat dinner and that's it. i'm 22 and have lived on my own since i was 18 and we still fight regularly if i don't lie and tell her i've eaten)....i still remember fighting with my mom when i was younger until i broke down in tears and gave in and had to choke down whatever food she put in front of me even though I wasn't hungry in the slightest.

Congrats Batts, you'll adjust right away and will not regret it! 

[quote user="Happy Vegan"]

Congrats to you Batts. I hope it all goes well.

Now you can look forward to changing your pump site while half awake ;)

[/quote]

i doubt i'll get like that, the infusion sets are more complicated than my syringes :P

[quote user="Batts"]

I'm doing it because my lifestyle is so crazy doing shots isn't really working and I can't get my A1C down. As much as I love them, I have to give the pump a shot to see if it'll help and make things easier. i am going to go back to my shots if it doesn't help my A1C.

i've got an anexity problem with giving up my needles because i'm so used to them..i can't remember when i didn't have to take them so it's kinda like a security blanket for me, which is why i'm scared about it. it's a huge change, but maybe it's going to be for the better. i think i just assumed and convinced myself it was never going to happen even though i've been talking about it. if my insurance wasn't going to cover it, i wasn't about to go out to the bank and get a loan for $7k to get one.

but i am excited about trying the pump now that i've talked to the rep about it and learnt more. i like the fact that i won't have to force myself to eat, my mom and i won't fight over me only eating two meals a day(on a good day, sometimes i have a small snack during the day and eat dinner and that's it. i'm 22 and have lived on my own since i was 18 and we still fight regularly if i don't lie and tell her i've eaten)....i still remember fighting with my mom when i was younger until i broke down in tears and gave in and had to choke down whatever food she put in front of me even though I wasn't hungry in the slightest.

[/quote]

OK.  Makes sense.  I hope it works out.  Best of luck.  Thanks for explaining! ;)  I wasn't trying to discourage you or anything, just curious.

 

[quote user="DDrumminMan"]

OK.  Makes sense.  I hope it works out.  Best of luck.  Thanks for explaining! ;)  I wasn't trying to discourage you or anything, just curious.

[/quote]

hehe i knew you werent trying to do anything like that.

don't worry, i'm still pretty anti-pump if you think about it ;) and we can still be needle-buddies! haha

[quote user="Batts"]

hehe i knew you werent trying to do anything like that.

don't worry, i'm still pretty anti-pump if you think about it ;) and we can still be needle-buddies! haha

[/quote]

Dear batts,

Sah-Weeeeeet.

Your needle-buddy,

Ddrumminman

 

Batts,

Many congratulations on the approval process. The fact that your insurance is picking up so much is realy good. I can't remember what my out of pocket cost was, but I think it was around $500. That was just because I had yet to max out my out of pocket expenses. You will hopefully come to cope with the loss of needles, but there good news is that if you ever want to take a pump holiday you can always still use the needles. Or if you don't want to bolus with the pump you could always do a shot. You will not be fully parted from the needles, also if you ever have a failed infusion set you would want to do a needle shot until you can get your infusion set changed. I still carry my humalog with me in my test kit just in case.

The fact that Animas is also trying to get you a price reduction credit is awesome, I know the Medtronic would have laughed at me, when I first switched to the pump. They wanted all the money they could get from myself and my insurance company.

Good Luck!

yeah i was pretty lucky. i was hoping they'd pay the full amount though cuz i hit my put of pocket expense amount back in march. but it's still better than them only paying 80% if i hadn't!

i talked to the rep a little bit ago too and he did drop the price $300 so i'm only paying $95 outta pocket.

That is awesome and $95 is a little easier to come by than $395. I hope this works out for you though.

I got approved for the pump also this week, but my part is 1800.00. It is the medtronics pump and cgm, my insurance pays 80%, I don't remember the full price, it is good that the company offered to get your part down to 95 dollars. The only help I got was that the insurance company offered to fiance it with 900.00 down. I haven't decided yet whether or not to go for it or not, but first I have to get the down payment. It seems like the thing to do now since it will make things better for me. Just so expensive.

yeah its so expensive that's why i wasn't going to consider it if i had to take out a loan and pay for it myself.

tho i could've gone through pharmacare and seen if they would cover it...thank god for being canadian!

 

i'm realy pleased with animas so far, not only cuz they knocked the price off, but also cuz the sales rep got me the trial even tho my first claim had been denied, the insurance lady called to check in with me and offered to help and gave me tips for when i applied the second time, and when i said i had to pay $395, i didn't mention that i couldn't afford to..she OFFERED to send the request to the sales rep to lower the price to $95 to make it easier on me!

That is truly awesome. Animas keeps moving up in my eyes as time goes by.

Yay Batts!  Congrats on getting the pump/the lowered price!  I think you'll love it once you get used to it, but if you still need your needles you could always inject saline...though I think you'll grow to dislike shots after a few weeks. 

congratulations Batts!! I was just like you back in march of this year when i decided to go on the pump. I was freaked out by not having to take shots anymore because it was something i did like breathing i thought it was going to be almost impossible to give up. but after about a week, my NEED for needles was gone and I love being on the pump. so best of luck to you.  

Ok, here's comes my post from my cynical side! 

It's nice that Animas dropped the price.  But really, it was just insurance gamesmanship on their part.  They tried to get as much as they could from the insurance company.  When the insurance didn't suck in, they, as we say in the business, dropped their shorts to get the sale.  I'm sure they still made a handsome profit.

About 10 years ago I had an 80/20 insurance plan.  I got my diabetic supplies for free.  A mail order company would inflate the prices and bill the insurance company.  They were happy and profitable with the 80% they got from the insurance company.

But, good job negotiating with them and I'm glad it worked out.