My Tandem t:slim pump’s four-year warranty expires very soon (my pump was billed/shipped out to me on August 31, 2012….I was one of the very first people in the world to have a Tandem pump, as I was told this was the FIRST day they were ever shipped to customers)…and now I’m in a bit of a pickle. I don’t like the idea of using a pump out of warranty, because if it breaks/malfunctions you are just SOL.
I have several roadblocks in my way to a new pump: first and foremost my insurance, secondly preauthorization, third…cost.
Insurance: My insurance plan is administered by UMR…which is a subsidiary of UnitedHealthCare. In fact, most suppliers and medical facilities just code my insurance as UHC. Unless you’ve been living under a rock the past few months you know that UHC and Medtronic are enacting an exclusivity agreement as of 7/1/2016 in which UHC is only covering Medtronic pumps (note: they have stated that in SOME cases they will cover other pumps, but the out of pocket cost will be higher for the patient, and this will be in special cases only). I am not a fan of Medtronic pumps and I DO NOT want to go back to one. If faced with the choice to use one or use injections, I’d choose injections.
Preauthorization: My insurance policy requires that I obtain preauthorization from them before a pump will be allowed to be billed. I have talked to the woman who is on the receiving end of those decisions (she then places the orders and bills insurance, for my one and only in-network provider (owned by the company for which I work)) and she has told me quite honestly that a patient already on a pump cannot get another one unless the one they are on is not functioning – even if the warranty was expired for years.
Cost: Even if I could somehow manage to get preauthorization for a new pump…even if I could somehow manage to get that pump approved as a new t:slim pump and NOT a Medtronic…the out of pocket cost to me would be about $1200-$1400 (and considering that UHC has said other pumps, if approved, will likely NOT be covered at the same benefit level, I’d likely be looking at a cost much higher than that..that is the cost only if it’s approved at an in-network price, but my guess is my insurance would say ‘ok, you got the authorization to get it, at an out of network pricing…which means my cost would be more than twice that quoted above (in network I pay 20%, out of network I pay 45%…). I’m already spending an average of $300-$330 a month on the cost of insulin, test strips, Dexcom sensors, Dexcom transmitters (one every three months), infusion sets, and cartridges. This doesn’t include the cost of the other things I occasionally buy too (alcohol wipes, Opsite Flexifix tape, SkinTac, Uni-Solve wipes, syringes to have as a backup, lancets, a new Dexcom receiver (and I use these out of warranty for at least a few months too, which also makes me nervous – I don’t have an iPhone as a ‘backup’ receiver…) Then I also have an annual out of pocket cost of around $750 for visits with the endocrinologist, CDE, retina specialist, labwork…. And this year I broke my arm – which resulted in an ER visit and two follow-ups with an orthopedist – which was an additional $700 in cost to me that I was not expecting. My husband and I recently moved and my cost for gas to drive to and from work went from about $30 a month to $130 a month. I got a newer better car and that price is now reduced to probably about $110 a month…but I also now have a car payment of just shy of $140 a month. I just paid $200 for two dental fillings…I could go on and on and on! In short – it’s not fiscally responsible. I have the savings, but I shouldn’t use such a huge chunk of it on a new pump.
So in short – I guess I’m using my pump out of warranty, for however long I can. For any of my readers using a pump out of warranty, or who have done so in the past – how long have you been/were you out-of-warranty? If you used an out-of-warranty pump and it finally malfunctioned, how long after the warranty expired did it happen? What did you do at that point – get a new pump (finally) or go back to injections long-term?
If you haven’t used a pump out-of-warranty, what are your thoughts on it? Would you do it, or would it make you really nervous? Would you even care?
I’d love to hear your thoughts!
EDIT TO ADD: I just reread the information about the exclusivity agreement between Medtronic and UHC. Apparently UHC is only covering supplies on other pumps their customers have as long as they are in-warranty. Once the warranty is expired if you want a pump OR supplies you have to switch to a Medtronic pump. Lovely. I better place an order next week – that will at least get me three more boxes of cartridges and three more boxes of infusion sets until I can figure something else out!