Insurance & Supplies

Handling day-to-day care of T1D can take a lot of effort. Insurance questions and phone calls can add an additional layer of complexity to your routine, but our diabetes care team is prepared to assist you with anything you may need regarding your insurance and diabetes supplies.

Check out our Insurance Guide for some suggestions on handling common insurance scenarios. For relevant updates to insurance policies that may impact our patients, check Insurance Updates.

Take the confusion out of health insurance with some of our tips and tricks!

 

Frequently asked questions

Where do I get my supplies?


You should receive your first month of supplies in the hospital. For more information, check Before you Leave the Hospital. Once you are discharged, you will be responsible for ordering your next shipment of supplies as well as subsequent refills. There are usually two different places that provide you with the supplies and medications you need for type 1 diabetes: your pharmacy and your insurance provider's preferred durable medical equipment (DME) company. A DME company usually provides medical equipment or specialized items not provided by your local pharmacy, typically through the mail. The pharmacy will usually provide: insulin, syringes, Glucagon, alcohol swabs, and urine ketone test strips. The DME company usually provides glucose test strips, lancets (poker), and in some cases, urine ketone test strips. You should check with your insurance company to find out where you can get specific supplies. If you have trouble getting supplies, please contact us at the clinic so we can help. Our office is trained to deal with insurance and DME issues and can help expedite the process.




What is a DME?


A durable medical equipment (DME) company provides some of the tools and supplies you need to manage diabetes. DME companies usually provide medical equipment or specialized items not provided by local pharmacites. Often, DME supplies are delivered by mail and larger items such as insulin pumps or CGMs may require an adult to be home to sign for delivery. A list of commonly used DME companies and their contact information can be found here.




What if my insurance won't cover supplies?


Call our diabetes team for assistance during regular business hours for help. You may also call your insurance provider and ask which DME company they work with. Your supplies may be covered under DME benefits instead of pharmacy benefits. Some common scenarios that our families face:

  • The supplies are not covered by pharmacy, but they may be covered by the DME company
  • Sometimes, the representatives you contact at your insurance company don’t have the most up-to-date information, and may be giving you incorrect information
  • Different versions of a medicine may be covered by different insurance plans. They may be different in name, but usually the same in effect. (Lantus vs. Levemir for long-acting insulins; Humalog vs. Novolog for rapid-acting insulins)




What if my insurance company needs "prior authorization"?


A prior authorization is a process that insurance companies use to determine if they will cover a specific type of medication or supply. This requires our diabetes team to fill out and fax a prior authorization form before you can get your medication and supplies. Prior authorizations are not immediate and can take days to weeks to be approved. If you are having issues getting supply refills in the short term, contact us and we can guide you through what to do.




What happens if I switch insurance?


You may have some problems with getting medications/supplies when you change insurance plans. Some common issues you may face include:

  • The new insurance plan has a supply covered by DME benefits, but the old plan had it covered under pharmacy benefits.
  • The new insurance uses a different DME supplier than the old one
  • The new insurance plan covers a different brand of supplies or different version of medication (e.g. different brand of insulin or a different glucose meter)
If you have any questions or need help communicating with your insurance provider, you may contact us for assistance.




How should I talk to my DME?


When you are ready to talk to your durable medical equipment (DME) supplier, it is helpful to have a list of information that includes your endocrinologist's name, phone number, and address, the name of the supplies you need, and copies of your insurance cards. Be sure to have a pen and paper handy to record the name of the person that you are speaking to, their phone extension, and/or email address, and any follow-up information that you may need.




How should I talk to my insurance company?


You should be persistent when communicating with your insurance company. They are large companies and often there are different individuals in the organization with different sources of information. We have had patients who were told that a specific item was not covered by insurance, but in fact it was. If you are unable to address your concerns with your insurance provider, please contact us at the clinic and we will assist you in communications.




What is Children's Special Health Care Services (CSHCS)?


Children’s Special Health Care Services is a Michigan state program designed to provide coverage for children under 21 with chronic diseases, including type 1 diabetes, who don’t have adequate insurance to cover their special health care needs. CSHCS will cover the cost of visits with providers, medications, and supplies for diabetes, but doesn’t provide coverage for health issues unrelated to diabetes. CSHCS can also help lower the costs of co-pays/deductibles for some children with private health insurance. Please contact our social worker to determine if your family qualifies and to discuss the application process. A cost chart can be found here.




We are losing our insurance coverage and can't afford our care or insulin. What can we do?


Our clinic will do everything we can to take care of your child's diabetes. Please contact our social worker to determine if your family qualifies for Children's Special Health Care Services (CSHCS) and to determine next steps for your child's health care. A cost chart can be found here. If you or someone you know between the ages of 0-24 is struggling financially and has to purchase diabetic supplies out-of-pocket, you can submit a request for help with paying for supplies from the American Board for Child Diabetics. Their website can be found here. If you are uninsured or have other circumstances that require you to pay out-of-pocket, check out these tips from the National Diabetes Volunteer Leadership Council (NDVLC) to reduce the cost of your insulin and other supplies. There is also this chart from the Association of Diabetes Care & Education Specialists (ADCES) that can help you find places to save on insulin.





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