Pumps and supplies

I have lived with Type 1 Diabetes for the past 20 years. I have not effectively managed my mental or physical health in the past decade. My sugars are erratic, I am hypoglycemic, and the difficulty of managing my BG is completely draining.

My current pump is out of warranty and my endocrinologist recommended the Tandem Control IQ and Dexcom G6. I have used Edgepark for the past 20 years for supplies. I contacted them to start an order for a new pump, CGM, and 3months worth of supplies. I was left with 1,100 to pay out of pocket. I told them I need to put this on a payment plan. The quickly told me they only offer use of a payment plan one time and I have already been provided this option.

I am in need of a reliable and responsive Durable Medical Supply Company that offer a payment plan for the pump. I have had zero luck finding companies with positive customer reviews.

All suggestions are greatly appreciated!

Hi @Lrmitche . I’ve been on a pump for about 30 years and a CGM for a bit less than that. The specifics may have changed a bit since then but there’s probably an approval/authorization process to go through for insurance to cover you: pump and CGM companies may need records or a summary from your physician - your doctor will know what to provide. Your doctor will put you in contact with the reps for Tandem.and Dexcom: they’ll take your information including insurance and work with your supplier to determine your coverage. I think coverage is the same regardless of which provider you choose as it’s based on your insurance - I’m assuming and greatly hoping you are not paying out of pocket. I used Edgepark for many years and they were excellent but had to switch last year and my rep had some insights on which other companies were good and which weren’t so hot. You should be able to switch if you don’t like the one you choose - just remember they’ll have to go through their own process with your insurance, which will take some time.
So before you start calling recommended suppliers please have your doctor connect you with reps. They know the ins and outs of working with insurance and suppliers and can make sure you’re getting your coverage.

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Excellent advice from Dorie, as always. Get in touch with the Tandem and Dexcom reps, and let them navigate what your insurance covers and how to get it supplied. They’re motivated to get it right, since that’s how they get paid, and they’ll know who is reliable and who isn’t.

Some day, Omnipod will have FDA approval for a similar system, and at least for us, pods are filled through pharmacy, not DME, which makes a ridiculously big difference financially. It sounds like you need the automation, so this isn’t a solution for you yet, but just something to keep in mind for the future.

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The Tandem rep suggested that I continue service with Edgepark and use the payment plan option.

I have met my deductible; therefore, insurance will cover 80% which leaves me to pay 1,100 out of pocket (which I am most certainly not able to do).

I need to get the ball rolling on this because if I do not have an order processing before Dec 31st then I will have to pay 100% out of pocket, or until I meet my deductible which is super high.

Did you let the Tandem rep know Edgepark said the payment plan isn’t an option, or were they on the phone with you to hear it directly? Like Dorie’s said before, the reps often know how to get stuff done that we just don’t, so if they can talk directly to each other, like maybe on a conference call, sometimes that can save some headaches.

I’m sure this is the last suggestion you want to hear, but since we’re so close to the end of the year and you will have to meet your deductible again in 2021 you might consider putting off your new pump until the new year. It will still be a financial sacrifice if your reps aren’t able to find something in your insurance, but that would get you started towards your 2021 deductible. I’m assuming your pump is still working fine - end of warranty doesn’t necessarily mean ends of its life, and if you have a backup plan and supplies for injections you might be able to make do until.
I’ve occasionally purchased pump and CGM supplies on Amazon or eBay so that’s an option if you need some to tide you through. If you currently use Dexcom G6 the supplies are the same whether or not you use Control IQ, but you may have to go through proper channels if you’re getting your first one.
Any better insurance options since we’re in “open season”?
Just food for thought.

I use Edgepark and I have used the payment plan twice.