The choices:
- Anthem Blue Cross PPO - $20 co-pay
- Kaiser Plan 20
The most important part of my coverage is prescription cost. The Anthem plan will have me paying $15 for generics (does Novolog even come in generic?), $25 for brand name with a $250 annual deductible. Kaiser's cost structure is $10 for generics, and $60 for brand name at a 100 day supply through their mail order service.
Does anyone have experience filling Medtronic or Dexcom orders with these plans? Anne of annetics.blogspot.com loves her Kaiser plan but its a different one than what my future employer (unveiled later this week) is offering. Not sure what else I need to look out for - any advice would be awesome!
4 comments:
If you can, try to find out how each provider deals with your pump and blood sugar testing supplies. I quite often have to justify to my insurance provider why I need more infusion sets (because sometimes they fail or get yanked out) or why I'm testing my blood sugar more often than usual (because of illness or a failed infusion set). The silly part about it is that I pay a percentage of the cost so it's not like I could be hording more supplies for a set amount of money. This year my provider also changed their deductibles so that while office visits to my general physician are $15, my endo visits now cost me $30. Watch out for little things like that. I think it's great that you have options available to you and you're doing your homework!
I had Kaiser Permanente when I lived in California back in the 1990's, and while I was fine with it, but the Kaiser model is somewhat different than the traditional PPO (Preferred Provider Organization), it is an HMO where Kaiser employs all the doctors rather than relying on doctors who are not on their payroll. But I found Kaiser's doctors to be great and very caring. But you may struggle to get new technology covered, as they use a different methodology to cover new technology. The same was true for pharmacies, although I don't know if that's true today. Notably, you will visit Kaiser-employed doctors but not necessarily the same endo each time around. You are also likely use Kaiser-owned pharmacies, rather than Medco or Caremark. My experience with Anthem was not as great. Anthem, which owns Empire BC/BS is owned by WellPoint, and I found their procedure to be "deny first, and make them appeal". Anthem is also a more traditional PPO, rather than an all-encompassing HMO. Some friends in California have complained that it's extremely tough to get Kaiser to cover insulin pumps if you don't already have one, but if you're already using one, they will continue covering the devices without too much trouble. Just be advised that the HMO model is not the same as the PPO model, so you might want to read up on the differences.
I haven't had either of those two specific plans, but I have generally had good luck with blue cross PPO's in a variety of forms/states. Endocrinologist (e.g., specialist) copays tend to be higher than regular GP visits under many plans, so consider that - also be sure to look at how they handle things like bloodwork. Remember that most test strips don't qualify as "generic," nor does any insulin I've ever seen. I think I've even had to pay brand name co-pays for things like glucagon (which kills me since I never actually use the kits and just end up chucking them upon expiration). Also, I have found that Medtronic will often go to bat for you and/or can tell you more about coverage if you get the respective plan group numbers from your employer and call in advance.
Make sure you check out the fine print about DME (durable medical equipment). My Anthem policy has a $2000/year cap. It's only September and I've already blown through that, so it looks like no more test strips or pump supplies for the rest of the year.
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