Navigating insurance benefits can be daunting to say the least. Here are a few things that might be helpful to know. Most people with insurance have a pharmacy benefit, and a medical benefit. It is important to check the pharmacy and medical benefits so that the plan can be utilized appropriately for each person. Not all places process the medical benefit along with the pharmacy benefit. However, Diabetes Specialty Center does process and check both benefits. Sometimes going through one benefit over the other can save considerable amounts of money over the course of the month and year. When it comes to diabetes test strips, supplies, and now continuous glucose monitors (CGM) they can often be covered under either benefit, but people do not always realize this is available. In checking both benefits to see what is available it empowers you to make an informed decision.
Costs of testing supplies can vary due to the insurance coverage, and where you are getting your supplies. Companies can negotiate with insurance plans on their contracts and what is covered. Through some companies you might not have a co-payment on testing supplies, while with others you will. This is due to the contracts each company has negotiated.
Insurance companies usually have a preferred meter. If the meter you are using is not the preferred meter of the insurance company, test strip costs are higher. Through some insurance plans going through the medical benefit allows flexibility in which meter is used. It does this by taking the preferred meter status out of the question since that applies on the pharmacy benefit side. This is not always an option, but it does not hurt to check.
Being pro-active about the benefits you have available is your right. Also, it does not hurt to shop around to see options of services and costs that are available with different companies. A gentleman we work with has tertiary (triple) insurance coverage, and was still paying a twenty dollar co-payment for supplies each month. After doing a benefit analysis he was thrilled to find out he would no longer have a co-payment for supplies. Ask today for a benefit analysis on your medical and pharmacy benefits. Checking this each year can be beneficial as contracts can, and do, change for supplies.
Diabetes Specialty Center is a local diabetes supply company that has store fronts in Utah, and also ships free of charge. 1-800-775-4372