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Post-Approval Blues.

February 27, 2009

I just got off the phone with Medtronic Minimed regarding a bill for $3,024.50.

Yes, you read that right. THREE THOUSAND. And twenty-four dollars. And fifty cents.

As most of you know, I was approved last fall rather swiftly for a Minimed CGM. This required me to upgrade from my 715 insulin pump to a 722 insulin pump. The pumps look and feel the same, except for an extra menu option which allows me to program and use the CGM. One gadget, two sets. Perfect for a technologically challenged girl like me.

Three weeks after my CGM arrived, I received a statement in the mail from United Healthcare saying that they had paid a certain amount of money to Minimed. But not all of it. The next day, on New Year’s Eve, I received a bill from Minimed. For $3,024.50.

I called up Minimed. I told them that they told me I was approved for a new Minimed insulin pump and that United Healthcare would cover it. Which they sent to me. I told them they told me I was approved for the CGM and that United Healthcare would cover it completely. Which they sent to me. At no point during this two month discourse that I had with Minimed was there ever an out-of-pocket cost mentioned.

So I told Minimed, flat out, that I refused to pay the bill.

“I will send this back before I pay three thousand dollars,” I said. The customer service agent said that he would take care of it and that it was probably a simple clerical error. I was satisfied that it would be taken care of.

About a month later, I received another bill. For $3,024.50. Again, I called Minimed to clarify that I will not pay for this because I’m NOT SUPPOSED TO. So they said, “Okay, we’ll take a look.”

A couple weeks later, I received a phone call at work, from a woman presumably wanting to know why the hell I haven’t paid my bill.

Again, I told her (as nicely as I could muster), “I’M NOT PAYING. STOP ASKING.” Actually, I explained the situation and that someone (two someone’s actually) were looking into this and that United Healthcare was supposed to cover the whole thing (and by the whole thing, I meant the CGM sensors). The woman took down the notes and that was that.

Last night, I opened up my mailbox, hoping that my delinquent 1099s would arrive so I could finally pay my taxes, only to find YET ANOTHER bill from Minimed for $3,024.50. Sensing a trend yet? I tweeted online that I was frustrated that Minimed kept billing me and they couldn’t settle this with United Healthcare. United Healthcare APPROVED this, how hard can it be?! Several other members of our community wrote me back, sharing their own experiences of having post-approval blues.

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Because I am an active, conscientious participant in my health care, I decided to give Minimed yet another call this afternoon to see if I could figure out what why progress on the situation was moving like molasses. I explained to the woman – yet another one – that I had received several bills from Minimed after they had declared I was approved for 100% coverage from United Healthcare. She told me that they had noted that I had called in about this and that they were currently discussing the situation with United Healthcare and that it was “Pending”. She said that I could call back in a couple of weeks and hopefully it would be resolved.

Before I hung up, I decided to ask her a quick question that had dawned on me last night as I was looking at the bill. The amount, $3,024.50, seemed strangely high for 3 boxes of sensors and a transmitter after partial coverage (United Healthcare did indicate they were going to pay roughly $1600). I asked her what the bill was actually for – the CGM sensors or the insulin pump upgrade.

She told me the bill was for the pump upgrade.

The UPGRADE? Getting an insulin pump is hardly new! Thousands and thousands of people with diabetes are on the insulin pump. Getting an insulin pump isn’t supposed to require a fight for approval! Are these people nuts? United Healthcare has never even paid for an insulin pump for me. I received my last insulin pump when I was still on my parent’s insurance plan.

Needless to say, I’m rather aggravated and disappointed that what I thought was going to be a seemless, smooth process has had so many bumps. Obviously, I flatly refuse to pay for an insulin pump upgrade. While I know it can cost several hundred to a thousand to get an upgrade before the warranty is up, that certainly isn’t what I agreed to.

I plan on staying on top of this as it progresses. It’s disappointing, too, because thus far I have had such good relations with both Minimed and United Healthcare. Minimed’s pump is wonderful and I wouldn’t switch from it. The CGM works really well for me (I plan on posting a more detailed look into my life with the CGM later next week). United Healthcare has, so far, paid 100% for my insulin, test strips and pump supplies. Except for the $15 co-pay on my doctor’s appointments, I have not paid anything towards my diabetes supplies. I realize how lucky I am. Edit: But United Healthcare is being ridiculous and slow. I realize that this isn’t Minimed’s problem, but it’s frustrating to be in approval limbo even after I’ve been approved!

But that does not mean a twenty-three-old entry-level young woman living in one of the most expensive metropolitan areas in the world can afford an insulin pump that costs THREE THOUSAND. And twenty-four dollars. And fifty cents.

14 Comments
  1. February 27, 2009 3:09 PM

    Actually, the problem is ENTIRELY UHC the insurance company. I have been doing medical billing for over 13 years. The problem with insurance companies is, they can pre-approve something but the claim is not considered until it is recieved in the claims department. Once they process the claim there are a million things that could cause a denial and confusion because most claims are adjudicated electronically. The insurance company holds the power, unfortunately. The doctors and suppliers aren’t the bad guys. Insurance companies are pure evil. Make sure all billing codes from Medtronic are correct to start. I can help you from there is you need……..

  2. February 27, 2009 3:24 PM

    @Kelly: I knew from the beginning it was not Minimed’s fault and that it was the insurance company, I was just frustrated because it felt like no progress was being made. Your explanation of what could be causing the problem is very helpful, though, so thank you for sharing! I don’t have an issue with Minimed, I’m just sad that for the first time in my relationship with Minimed I’m having an issue! I’ve had a spotless record so far!

  3. California permalink
    February 27, 2009 3:25 PM

    I agree with Kelly. I would start fighting United Healthcare. I work in a medical institution and they do this sort of this all the time (or worse). This is business as usual.

    • February 27, 2009 3:26 PM

      @California: Ugh. I hate fighting insurance companies! Well, like I said, Minimed is still tackling this for me so if things don’t approve by the end of March I may have a word with the higher-ups.

  4. California permalink
    February 27, 2009 3:54 PM

    Allison–Me too. I’m really sorry you are having to deal with this.

  5. Nicole permalink
    February 27, 2009 4:43 PM

    Allison – I’m wondering if you’ve looked at your insurance benefits to see if you have a cap on DME. This would result in a bill around the amount you’re looking at for a pump/CGM. It could be that you had already exhausted your DME benefits (with supplies, etc.) before the end of last year. UHC then ‘approved’ the pump – and paid up to the cap – and you’re left with the balance.

    This is the situation I was in at the close of last year – and I had to jump through hoops to get the pump approved AND then to get them to waive the DME cap and cover what was left of the cost. They did it – but it did require a phone call from me (phone calls from the pump company did NOT suffice)…

    Just a thought.

    • February 27, 2009 4:47 PM

      @Nicole: I haven’t, actually. That’s an interesting theory. I wonder why they said I was approved 100% though and then told *after* that I was covered. That seems pretty fishy to me! If this doesn’t clear up by the end of the month, I will give United a call to see what I can do. Do you think this is something they would have told Minimed during the first phone call though? I feel like someone should have mentioned that little fact by now!

  6. Nicole permalink
    February 27, 2009 4:58 PM

    Allison – If it has to do with your DME cap, it won’t clear up with Minimed alone. And Minimed might expect you to KNOW what your benefits are – that’s how it went with me anyhow.

    The first thing I would do is call UHC and ask if you have a cap on your DME. If they say yes, you have your answer – and you’ll have a little work to do. The next thing to do (if you have a cap) is ask your employer who your UHC Rep is (the person that sold the company the insurance). Then call that person and ask them if they can make an exception to the cap, given the circumstances. Explain that 1) you need this pump 2) you won’t need another large DME expense like this for another four years and 3) you would be grateful for their help on this. I worked for a small company – and getting this overturned was not difficult at all.

    The amount sounds very much like the result of a DME cap to me.

  7. Nicole permalink
    February 27, 2009 4:58 PM

    My cap would have left me with a $3122 balance.

  8. Nicole permalink
    February 27, 2009 5:09 PM

    And the way Minimed looks at it, and UHC for that matter is that you are “approved” for coverage. They just pay up to what the limits on your policy are. It’s not that they didn’t approve the service – they just won’t pay over your cap… Does it make sense? Sort of. But someone should have figured it out by now… I know when I was looking at pumps, they didn’t tell me that there was a limit – I found that out by asking BEFORE I agreed to purchase – and I didn’t have them ship until AFTER I got the cap overturned.

  9. Sara permalink
    February 28, 2009 12:11 AM

    I also had to get my cap overturned or would have had a similar amount of a bill like the one you are looking at (I just woke up from a nap so I know the grammar of that sentence sucks). Thankfully, getting the cap removed was very easy. The rep was actually at my work for open enrollment so I walked up to her, held up my pump, said I needed a new one and that they were not covering enough of it (they had never paid for a pump for me before). She says, ‘well that doesn’t seem right’, called her boss, and my cap was overturned for as long as I stay with the company.
    I think it is quite a shame that your HR or benefits administrator didn’t do a better job of laying out the details of your coverage for you, if this is in fact the cause of your higher bill.

  10. Nicole permalink
    March 3, 2009 10:54 AM

    Any word, Allison? I’m curious what you found out… – Nicole

    • March 3, 2009 11:14 AM

      No, not yet. I was sick yesterday so I didn’t have a chance to call and find out. I plan on doing it today or tomorrow.

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