Humana, Medicare and insulin

Go Back   The Diabetes Forum Support Community For Diabetics Online > Diabetes Forum Community > Diabetes Treatment > Insulin Pumps

Insulin Pumps If you are considering going on a pump or you already use a pump, please ask your questions, share your experiences, and discuss related issues in this section.


Humana, Medicare and insulin


Reply
 
Shared Thread Thread Tools
Old 10-10-2019, 15:04   #1
Active Member
 
Join Date: Mar 2017
Location: North Carolina USA
Posts: 8

Member Type
Type 2
Diagnosed in 2005

3 likes received
Default Humana, Medicare and insulin

In Jan. 2018 went to pick up my insulin at my pharmacy and was told Humana told them that if it was for a pump it had to be billed under part B. As they don't bill part B so a scrambled around town and found no one will bill part B till I got to Sams club and they would, so since then I have been getting my insulin from them.
Went to pick it up yesterday and it was $70 dollars more than last time. Asked why and was told I was in the donut hole with my insurance. Said I was under part B and should not be there. Druggist called medicare and was told that since I was with Humana HMO that it had to be billed under part D
My questiion is if I go under just Medicare and not Humana will my insulin be paid for?
Tried to call Humana and Medicare but after being on hold for 30 minutes from both of them I gave up and came here to see if anyone can answer.

Greysquirrel is offline   Reply With Quote
Old 10-10-2019, 17:07   #2
Moderator
 
moon's Avatar
 
Join Date: Feb 2011
Posts: 6,042

Member Type
Type 2
Diagnosed in 2011

5693 likes received
3331 likes given
Default

I don't know the answer since I'm just Medicare, but it sounds like the problem here is that your private insurer is the primary one and Medicare is secondary so ... coverage from primary rules.

There's a phone number here (scroll down) you might try if it wasn't one of the ones you already did.

__________________
Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

moon is offline   Reply With Quote
Old 10-11-2019, 03:58   #3
Moderator
 
mbuster's Avatar
 
Join Date: Sep 2011
Location: SW Arkansas
Posts: 8,972

Member Type
Type 2
Diagnosed in Feb. 2012

10937 likes received
6038 likes given
Default

I am just looking in to Medicare, I'll be 65 the end of April. My understanding is that just Medicare (Part A and B) doesn't pay for most prescription drugs. You either have to have a Medicare Advantage Plan or carry the supplemental Medicare Part D. I'm not sure what I will do yet other than sign up for Medicare as I will be employed and covered by my company's insurance plan until I retire. Was planning on doing it on my birthday but may go until the end of the year or wait until I'm 66 and 2 month to draw full social security.

I think you need to get up with someone to discuss the options to find what might be best for you. I think it's open enrollment time for next year.

__________________
Think I've had this since 2003. Told I was Type 2 lean on 2/13/12.
a1c 8.8 (8/2011) 5.4 (10/2018)
TC 206 LDL 102 HDL 85 TG 96 (10/2018)
Supplemental vitamins and electrolytes
63 YY Love the LCHF diet. The cheese goes well with my whine

updated 10/26/18
mbuster is offline   Reply With Quote
 
Old 10-11-2019, 14:23   #4
Active Member
 
Join Date: Mar 2017
Location: North Carolina USA
Posts: 8

Member Type
Type 2
Diagnosed in 2005

3 likes received
Default

Moon
Maybe I did not make myself clear. I know if I am on a Humana plan that I have to get my insulin charged to Part D what I am PO about is that Humana told my driggest two kyears ago that inluin for a pump must be paid through Part B so I ran all over town till I got to Sams and they said they could do it, then Humana change my plan to a HMO so that changed things. As you are on Medicaid and I assume on a pump as you are on this forum what I want to know is if I dump Humana and Pard D and just go on Medicar will it pay for my insulin for my pump?


Last edited by Greysquirrel; 10-11-2019 at 14:26.
Greysquirrel is offline   Reply With Quote
Old 10-11-2019, 23:19   #5
Moderator
 
moon's Avatar
 
Join Date: Feb 2011
Posts: 6,042

Member Type
Type 2
Diagnosed in 2011

5693 likes received
3331 likes given
Default

I have no experience along these lines since I don't use a pump (am on MDI which always falls under Part D) and Medicare is my primary/only insurer (except for MediGap).

How frustrating for you! The only way to navigate this I think is to sit on hold with Humana until you can talk to someone. My experience with Medicare is loaded with getting bad information, or misleading/incomplete at best, which is why I'd start with Humana.

Another option would be to try your local SHIP office. A list of phone numbers by state can be found here if you click on the Find Local Medicare Help button at the top. It might involve making an appointment with them, but they can be enormously helpful.

Please let us know what you find out. Am hoping it can be resolved in your favor and fast! Good luck.

__________________
Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

moon is offline   Reply With Quote
Reply

« CGM reliability | - »

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off


LEGAL NOTICE
By using this Website, you agree to abide by our Terms and Conditions (the "Terms"). This notice does not replace our Terms, which you must read in full as they contain important information. You must not post any defamatory, unlawful or undesirable content, or any content copied from a third party, on the Website. You must not copy material from the Website except in accordance with the Terms. This Website gives users an opportunity to share information only and is not intended to contain any advice which you should rely upon. It does not replace the need to take professional or other advice. We have no liability to you or any other person in respect of any content on this Website.


All times are GMT +1. The time now is 09:22.




Powered by vBulletin®
Copyright ©2000 - 2019, vBulletin Solutions, Inc.
Search Engine Optimization by vBSEO
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2019 DragonByte Technologies Ltd.
User Alert System provided by Advanced User Tagging v3.1.0 (Pro) - vBulletin Mods & Addons Copyright © 2019 DragonByte Technologies Ltd.