July marks the beginning of a new insurance year.
This year, my co-pay for a visit to my doctor increases (from $25 to $30 for a specialist, from $20 to $25 for my PCP).
This year, my portion of the payment for durable medical equipment DOUBLES (coverage by my employer goes from 90% to 80%). Considering how much OmniPod supplies are, this is definitely not something I can afford.
Last year, I wrote about my experiences with wanting to switch to the Animas Ping, due to the amount of insulin I lost if a pod malfunctioned. I think I fell off the blogging bandwagon, because I never followed up. To make a long story short, my insurance company denied my appeal saying I was still under warranty and that Insulet should be replacing my pods. Not what I was arguing, but okay. I decided to give it a rest and just look for a new pump when my warranty expires in 2012.
However, due to this massive increase in my co-insurance for DME, I decided to try for the Ping again. The cost of supplies on my part will be way cheaper and easier for Chris and me to afford (keep in mind I’m the only one working a full-time job while Chris is in pharmacy school full time. We’re not exactly rollin’ in dough, haha).
An Animas rep called me back the day after I faxed over my paperwork. He said he had seen my paperwork from last year, and I explained what happened and what I was trying to do. Then he said, “So I guess you want to do AAP, right? It doesn’t go through your insurance.” Obviously I was confused and didn’t know what AAP was…
He explained– and apparently for me, the pump gods and the stars were aligned. It’s the Animas Access Program, and it lets you trade in your current pump for a recertified Ping for $200! Well, you pay $900 up front, and upon receipt of your current pump, Animas gives you $700 back. Oops, wrong info! You actually pay $200 up front, and if don’t send your current pump to Animas within 20 days of training, you’ll be billed $700. The warranty on your current pump also carries over (you’re covered for at least 2 years on the Ping, even if your current warranty is that long). Sounds like a pretty good deal to me! Insurance doesn’t pay for anything, and I get a “new” pump for $200!
My first reaction was “Why didn’t anyone tell me this last year?!” Turns out it’s only available during certain times (of the year, of the decade, I don’t know).
After talking over it with Chris (and asking him to do some research, because I was still in that “this sounds too good to be true” mindset), we agreed that we should push forward with this. My other option was to go back on MDI if I was denied again, but it looks like I won’t have to.
A pump consultant will be contacting me on Monday to go over next steps and what I need to do. I’ve already called my endo’s office to give them a heads up that a certification of medical necessity is needed soon. I know my endo is very on board with me switching pumps, given the issues I was encountering before, so it shouldn’t be a problem.
I’m trying not to get my hopes up in case something falls through, but I’m VERY excited!