[mikael]

Hello everyone.

I'm a new here. I live in Scandinavia and everything here regarding the diabetes is quite simple: I get all supplies for free. It is possible that I will get an offer from one of the U.S. university (I have a Ph.D. degree). So, I started to read about diabetes treatment there. If I understood correctly, all medical care in the U.S. has direct connection with the insurance. I know that university will pay that for me, but I still have some problems with understanding of this system. In particular, how can I know if insulin, supplies for the insulin pump, strips will be covered by the insurance? If it will not, does it mean that I will need to pay the full price? I believe that my questions seem very silly for most of you, but I've never used any insurance in my life...Thank you in advance!

 

[Cricket]

Hello everyone.

I'm a new here. I live in Scandinavia and everything here regarding the diabetes is quite simple: I get all supplies for free. It is possible that I will get an offer from one of the U.S. university (I have a Ph.D. degree). So, I started to read about diabetes treatment there. If I understood correctly, all medical care in the U.S. has direct connection with the insurance. I know that university will pay that for me, but I still have some problems with understanding of this system. In particular, how can I know if insulin, supplies for the insulin pump, strips will be covered by the insurance? If it will not, does it mean that I will need to pay the full price? I believe that my questions seem very silly for most of you, but I've never used any insurance in my life...Thank you in advance!

There are no silly questions, but the answer depends entirely on the insurance policy you are covered under.

 

[mikael]

There are no silly questions, but the answer depends entirely on the insurance policy you are covered under.

Thank you. So, it means that I need to contact an employer for further information? But let's imagine that my insurance will not cover anything, does it mean that I will have to pay the full price from my wallet or there is some support from the U.S. government?

 

[VeeJay]

It will require a prescription from your doctor in order for them to consider covering any medical supplies or medications. They won't accept a request directly from you.

What is covered is, of course, determined by the insurance company. I would think a university would have a contract with a good insurance company. You may not have any difficulties.

Some insurance companies only cover certain brands. What you may want to find out is if the brand of pump you are using is something available in the U.S., and if the university's insurance covers it.

 

[VeeJay]

But let's imagine that my insurance will not cover anything, does it mean that I will have to pay the full price from my wallet or there is some support from the U.S. government?

I don't believe there's any government support here like what you are used to.

 

[mikael]

Thanks, VeeJay. It becomes more clear for me. If I am not mistaken, it is possible that my insurance will cover 100%, but it has to be asked from an insurance company, is it right?
You also mentioned that I have to ask for a prescription from a doctor. Did you mean for insulin or also for insulin pump supplies?
By the way, do you use Accu-Chek pump in the U.S.? Is it possible that an insurance company will pay for a new pump?

Thank you.

 

[VeeJay]

If I am not mistaken, it is possible that my insurance will cover 100%, but it has to be asked from an insurance company, is it right?

Yes, the doctor has to send a form to your insurance company requesting the pump. Whether or not the ins. co. will cover the pump 100% depends on them entirely.

Did you mean for insulin or also for insulin pump supplies?

Both.

do you use Accu-Chek pump in the U.S.? Is it possible that an insurance company will pay for a new pump?

I think I have read of folks being on this pump, but not sure.

Now, you understand, I don't have any direct experience with this. I have some understanding of how it works for pumps and supplies because some forum members have described their experiences.

Your employer may be able to give you a copy of the coverage information their insurance company publishes for policy holders (the employee). That should outline what they cover. It may name pump brand(s), what supplies, and type of insulin covered.

 

[mikael]

There are no silly questions, but the answer depends entirely on the insurance policy you are covered under.

Yes, the doctor has to send a form to your insurance company requesting the pump. Whether or not the ins. co. will cover the pump 100% depends on them entirely.

Both.

I think I have read of folks being on this pump, but not sure.

Now, you understand, I don't have any direct experience with this. I have some understanding of how it works for pumps and supplies because some forum members have described their experiences.

Your employer may be able to give you a copy of the coverage information their insurance company publishes for policy holders (the employee). That should outline what they cover. It may name pump brand(s), what supplies, and type of insulin covered.

I see...I start to have some doubts if my salary will be enough to live in the U.S. :smile2: I believe that doctor's visits also can be covered by the insurance?
And one more question...Do I need to visit a doctor every time when I need insulin/pump supplies or the prescription can be given, for example, for a year?

 

[Cricket]

I see...I start to have some doubts if my salary will be enough to live in the U.S. :smile2: I believe that doctor's visits also can be covered by the insurance?
And one more question...Do I need to visit a doctor every time when I need insulin/pump supplies or the prescription can be given, for example, for a year?

Again, it depends entirely on your insurance, and it some cases your doctor.

I am not on insulin, but my co-pay for doctor visit is $25 per visit. Initially my doctor had me come in every 3 months or so for a new prescription, but now he writes refills for 6 months. My co-pay for the meds, depends on the prescription as well, but definitely way less expensive than full payment.

 

[mikael]

Again, it depends entirely on your insurance, and it some cases your doctor.

I am not on insulin, but my co-pay for a doctor visit is $25 per visit. Initially my doctor had me come in every 3 months or so for a new prescription, but now he writes refills for 6 months. My co-pay for the meds, depends on the prescription as well, but definitely way less expensive than full payment.

OK, thank you very much, everyone, for your help. I understood that I should contact the insurance company to obtain the required answers. I possibly will come back with more questions later :smile2:

 

[Bunjee]

I'll let others answer the other questions, but if your pump is not covered by the insurance from the University, your doctor here in US can request an exception since you already have a pump. Most insurance companies will authorize that since they would otherwise have to replace the pump.

 

[Fran_C]

Hi Mikael;
I agree with the information posted by others today.
One important additional question for your new employers
What is the deductible on the insurance plans you offer employees AND what is the out of pocket max on the policy.
Normally universities offer very good insurance programs to their employees unfortunately not the case with private employers.
I want to offer an example so that you go into the new job with a clear understanding of your possible health insurance expenses.
I have insurance through my wife's employer
Our combined deductible is $3500/yr. That means first $3500 of medical/drug expenses each year come out of our pocket. The insurance company does control the max a physician or hospital can charge for a given procedure.
After the deductible is "met" the insurance company pays a large percentage of the cost of the physician services or drug/insulin supply costs.
Our out of pocket max is $5000/yr. That means once we accumulate $5000 dollars in out of pocket medical expense, all in network medical/drug expenses are covered by the insurance company until the following January when the vicious cycle begins again.

Personally I think this is a primative system, but it is a way of life in the US.

Fran

 

[mikael]

Hi Mikael;
I agree with the information posted by others today.
One important additional question for your new employers
What is the deductible on the insurance plans you offer employees AND what is the out of pocket max on the policy.
Normally universities offer very good insurance programs to their employees unfortunately not the case with private employers.
I want to offer an example so that you go into the new job with a clear understanding of your possible health insurance expenses.
I have insurance through my wife's employer
Our combined deductible is $3500/yr. That means first $3500 of medical/drug expenses each year come out of our pocket. The insurance company does control the max a physician or hospital can charge for a given procedure.
After the deductible is "met" the insurance company pays a large percentage of the cost of the physician services or drug/insulin supply costs.
Our out of pocket max is $5000/yr. That means once we accumulate $5000 dollars in out of pocket medical expense, all in network medical/drug expenses are covered by the insurance company until the following January when the vicious cycle begins again.

Personally I think this is a primative system, but it is a way of life in the US.

Fran

Thank you very much, Fran. I was said by my possible employer that I will need to pay about 300$ per month anyway because I'll move with my family and they also, obviously, need an insurance. So, does it mean that in addition to that monthly payment I will also need to pay the deductible from your example? And to be completely sure, insurance will not cover anything unless I will pay 3500$ from my pocket? I just think...what if the payment will be, for example, 500$ (I have no idea about costs in the U.S.), I will have to pay it fully by myself?

 

[Fran_C]

Hi, the cost of the insurance (in your case $300/month) does not count against the deductible. The amount of the deductible is unique to each insurance policy ( as I suggested, please ask the new employer what YOUR deductible will be)
So in conclusion you are correct the insurance does not pay anything until the deductible is "met"

 

[mikael]

Hi, the cost of the insurance (in your case $300/month) does not count against the deductible. The amount of the deductible is unique to each insurance policy ( as I suggested, please ask the new employer what YOUR deductible will be)
So in conclusion you are correct the insurance does not pay anything until the deductible is "met"

I see...And yes, I understood that the amount of the deductible entirely depends on the insurance. I just simply cannot understand how, for example, I will be able to pay 500$ from my salary :smile2:
But yeah, thank you, everyone, again! I did not expect so much help here.

 

[Fran_C]

Yes affordability is the problem. Single payer system is the solution. But it is not going to happen here anytime soon.

Fran

 

[Cricket]

Thank you very much, Fran. I was said by my possible employer that I will need to pay about 300$ per month anyway because I'll move with my family and they also, obviously, need an insurance. So, does it mean that in addition to that monthly payment I will also need to pay the deductible from your example? And to be completely sure, insurance will not cover anything unless I will pay 3500$ from my pocket? I just think...what if the payment will be, for example, 500$ (I have no idea about costs in the U.S.), I will have to pay it fully by myself?

Again, it depends entirely on your insurance.

As an example, although I have a deductible, for simple things like doctor visits and medications, it doesn't involve the deductible. I pay what is called a co-pay. When I visit my doctor, I pay a flat $25 fee.

 

[mikael]

Again, it depends entirely on your insurance.

As an example, although I have a deductible, for simple things like doctor visits and medications, it doesn't involve the deductible. I pay what is called a co-pay. When I visit my doctor, I pay a flat $25 fee.

That's definitely would make the situation easier...I mean "a co-pay".