FUDiabetes

Insurance Qs for Tandem vs Medtronic

I have UHC with my employer and it clearly doesn’t cover Tandem pumps.
I wanted to know can I get a secondary insurance at the minimum time allowed on the plan to get the Tandem coverage through them?

Otherwise, I’d HAVE to get the medtronic pump. Which btw: If you had to choose between 630 g and 670 g, which would it be?

Thanks everyone!

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I wouldn’t think so, typically the primary insurance sets the coverage rules. I would check to see if UHC would cover the Tandem pump supplies first. There have been a few statements by UHC that make it unclear if they’ll cover the supplies if you were not already in possession of the pump upon your initial signup.

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If you end up applying for an exception, you can always use their own words against them. One of the key reasons for choosing MDT was supposedly that they were the only one with an insulin suspend based on sensor data, which Tandem now fully supports this safety feature. Plus the Dexcom sensors work better than MDT sensors, so you can always argue that.

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Here is UHC document, although details may be different for each plan.

https://www.uhc.com/medtronic

What if someone wants a different pump?
We will continue to have a clinical review process in place for prescribing physicians and members who feel a non-Medtronic device may be preferred. If a patient and his/her doctor feel there is a medical need to use a non-Medtronic pump, we will work directly with the prescribing physician on the request. If approved, an alternate pump would be covered at the in-network benefit level through a participating provider.

So you need to prove why another pump has medical benefits that medtronic doesn’t have, and possibly with less discounted price.

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sounds like possibly the somewhat recent news articles hyping the 670g exodus over user dissatisfaction (real or imagined) might help then…

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It would be interesting stats to see how many 670 users turn off auto, or use dexcom instead of guardian. I know many have posted that as their solution, or were able to trade in their pump to Tandem for cash price, through end of medtronic warranty.

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@mm2 it would be interesting, especially if you were able to qualify the sub-group versus the total 670G user base to determine a percentage of dis-satisfaction based on each dissatisfaction variable, then compare/contrast versus other pump mfrs.

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Here is one study.

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I cancelled UHC and switched because of this very issue. I was researching issues to prove to UHC but I was fortunate to be able to switch in time. One issue that I was going to have my Doc use, is that the Medtronic Automode bases its behavior on the previous week and your behavior patterns (sleep, work, exercise).

Not only can you not be human, for a female with constant (almost weekly) change of hormones and subsequent insulin requirements Automode would be a wild goose chase and would never get it right…

I wish you luck! I hope you can break through!!

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Where can I find this information in writing? I can’t seem to find it anywhere… that they claimed they were the only ones at the time providing insulin changes based on live-fed data.
Thank you! I am building my case…!

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Here is a link that is criticizing the original decision. You can see the comment in the link.

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image

Medtronic to Become UnitedHealthcare’s Preferred
DME Provider of Insulin Pumps for Diabetes,
Effective July 1, 2016

As part of our ongoing efforts to provide a better member
experience, while increasing quality and lowering the overall
cost of diabetes care in the United States, UnitedHealthcare
has reached an agreement with Medtronic to become the
preferred, in-network durable medical equipment (DME)
provider of insulin pumps for UnitedHealthcare Community
Plan and Commercial members, effective July 1, 2016.
Medtronic is a global healthcare solutions company
committed to improving the lives of people through its
medical technologies, services, and solutions and has been
a leader in diabetes care for more than 30 years.

The preferred relationship excludes UnitedHealthcare
Sierra Health and Life Commercial members as well as all
UnitedHealthcare Medicare Advantage members.

Our goal is to provide the opportunity for a better care
experience by providing our members with access to
advanced diabetes technology and comprehensive support
services while learning how advanced technology can be
applied to improve outcomes and reduce costs. We also
aspire to find new ways to analyze the total cost of care
for diabetes management, bring a value-based approach
to diabetes care for UnitedHealthcare members and place
greater focus on quality rather than the volume of care
delivered.

As part of this agreement, UnitedHealthcare members
with diabetes who meet the UnitedHealthcare medical
policy criteria will be provided access to multiple models
of Medtronic’s insulin pumps, including the MiniMed®
530G pump. The MiniMed 530G system includes safety
features that pause insulin delivery when sensor glucose
levels fall below a preset limit, helping the patient recover
at a quicker rate.

Please note: UnitedHealthcare will continue to cover
insulin pump supplies for all brands of insulin pumps that
our members currently use while their insulin pumps are in
warranty and are still functioning properly. They do not need
to make any immediate change to their pump and will not
transition to a MiniMed pump until their pump is both out of
warranty and not functioning properly.

What this means for you:
• There has been no change within our medical policy
for coverage of insulin pumps; this only applies to the
type of device prescribed.
• When UnitedHealthcare members need to obtain
their prescribed pump, they can call Medtronic at
800-646-4633 or visit www.medtronicdiabetes.com/
preferred.
• UnitedHealthcare members who are 18 years old and
younger may remain on their current insulin pump and
are not required to use a MiniMed pump.
• If one of your patients is a UnitedHealthcare Sierra
Health and Life Commercial member or a Medicare
Advantage member, the preferred relationship does
not apply. However, you may still prescribe them to a
MiniMed insulin pump as you see fit.

We thank you for all that you do as we strive to provide the
best possible outcomes for our members with diabetes.

If you have questions, please call the number on the back of
your patient’s member ID card. Thank you.

Network Bulletin: May 2016

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My ears are burning…

Or whatever happens when someone is talking about your people…

If you’re looking for personal stories of Auto Mode disasters, @T1DNurse, I can take you to the end of the rainbow. :hugs: Seriously, I have a group of my own (absolutely no pressure) where we speak openly about the many, many, many, many flaws of auto and the 670G and where lots of people are fleeing its tangle of…many flaws. It’s a general diabetes technology group, so you’ll also hear people working out their t:slim issues, G6, Libre and on and on, but it was originally a 670G group—so it remains a big emphasis. I’ve posted very boring documents in there before that people have actually printed and handed their doctors to help their case. In my mind, the unhappy 670G user (or frustrated to be fair) is the most common member you’ll find in the group. For now, it’s just barely beating out the incredibly relieved t:slim user… because that group is growing by the day.

I hope you won’t feel pressure to join the group. I only mention it because of your current mission. Either way, I wish you the best of luck!

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Sounds like a great group. What’s the link?