Insurance co-pays

Type 1 & LADA
1

I have Cigna insurance and they use an intermediary called CareCentrix to authorize me getting my Dexcom G6, Tandem pump, and associated supplies. Cigna approved the Tandem pump and I got it directly from Tandem. Under my insurance I am responsible for a 10% co-pay of durable medical equipment. When the pump was approved, Tandem called me and asked if I was okay with a co-pay of $400? This was my co-pay based on a pump price of $4000. I said “yes” and got my pump (which I love my the way). The surprise came about a month later when I got a bill from CareCentrix for $680. They claimed that the pump cost was $6,800. I called Tandem and when I told them the problem they said that they were under a non-disclosure agreement and could not say more. I told them what they had told me my co-pay would be and they said that they could not say anything more.

I subsequently called Cigna. The representative on the phone told me that Cigna and CareCentric negotiates a price for the pump that they pay, but then claim that they pay a higher cost so that they can get a higher co-pay out of me.

This sounds like fraud to me. I looked on-line and there are a bunch of case-action lawsuits in some states about this issue on non-diabetic type of stuff.

I am curious if anyone else has had this issue come up with their equipment or supplies.

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2

Tandem receives very close to $4000 for the pump. (In the USA. International is different.)
Insurance companies can say it costs whatever they want to say it costs.

Sounds like your insurance is playing games and wants you to pay a higher copay.

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Does Cigna or CareCentrix approve ? Does Cigna or CareCentrix set the cost?

If employer based plan, I suggest you contact benefits/HR for clarification.

Does Cigna provide an EOB (explanation of benefits) ? If so, which amount is shown as your responsibility.

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4

I would ask your insurance company for a copy of the PO they used to pay Tandem. If it says $6800, I would call Tandem and ask them to verify. If it says $3995, I would remit the correct amount to the insurance company. My guess is they sell it inside the company to raise the price after purchasing it from Tandem for approx. $4000. If they are unwilling to share the PO, I would send $400 and prepare to fight it out.

5

Should I mention four years of supplies?

The pump is only half of it.

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6

I was no including the cost of the supplies

That was a separate charge

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