Healthcare Costs and Type 1 Diabetes
This morning, my check up at the endocrinologist turned into a discussion of our out of control healthcare system and its costs. He looked a little surprised when I told him that I personally had to pay $2500 for a new pump. My insurance has a $2500 cap on DME (Durable Medical Equipment). So, of the $5500 cost of a new insulin pump, United Health Care will pay $2500, Minimed will give me $500 trade-in on my current pump, leaving me $2500 to pay.
Imagine, if you will, a single parent earning a modest living. Imagine, also, a family of 4 dealing with high rents or a variable mortgage, school, clothing, food, and the like, on a modest income. I complain about these costs, but I know that many people are trying to deal with these on less income than I am.
When I got my current pump, in 2002, I had Cigna. Cigna and Medtronic-Minimed had a negotiated price of $4500, and I had to pay 10% of all DME. So, my out-of-pocket was $450. Every 3 months, I paid 10% of the cost for the insertion sets and insulin reservoirs that you change every three days. That came to around $45, every three months.
In the past 3 years, though, with Blue Cross Blue Shield, and now United Health Care, I have had a deductible to meet before they start paying. Currently, I have a $750/family member deductible. So, my first two boxes of pump supplies, each year, are mostly out-of-pocket. Luckily, I still only have to pay $10 copay each for my monthly supply of glucose test strips and insulin.
So, let’s return to our exemplary family. For the first half of each year, someone with a child on a pump, with insurance like mine, would pay $20 each month at the druggist, then $125 each month for pump supplies ($750/6). The second half of the year, once the deductible is paid, requires $15 per month; assuming that copay is still %10 for durables. For the pump itself, Medtronic-Minimed can put you on monthly payments of $50 to pay off the $2500. Doctor copays of $20 every three months would work out to almost $7 per month ($6.67, roughly, actually.) So, for six months, the family would pay $202 monthly. Then, for six months, they would pay $92 per month.
Add to this the cost of any other care the child may need, and this adds up to an enormous cost for many families. If you’d like to find out more, or about organizations that help families dealing with the cost of a child’s diabetes care, check out Islets of Hope, and iPump are so important. If you have a child with diabetes, check out these sites, as well as Children with Diabetes, an online community for kids, families, and adults with diabetes.
I’ll post some info on the continuous glucose monitoring systems, now available, but not covered by any major insurance carriers.
Tags: diabetes insulin+pump endocrinologist doctor+visit children+with+diabetes medtronic-minimed type+1+diabetes
Jonathan
Thanks for bringing this important issue to people’s attention. And thank you for the location of the two sites, I’ve added them to the Diabetes Search Engine that I’m maintaining at http://bernardfarrell.com/dse.html.
Note that the Islets of Hope site is a .com, not a .org, so you should update the URL.
I see you’re an Irish music fan. I was raised on a diet of Planxty and other great trad irish groups. Do you like Seamus Ennis, the great uilleann pipes player? Last time I was ‘home’ in Ireland I picked up a double CD of his playing, bone-chillingly great.
thanks so much. I’m so sorry. My daughter is a professional Scottish musician (age 23) and constantly on the road, just diagnosed while on tour with Type 1 seven months ago. Her Freelancers musician’s insurance out of NYC didn’t cover anything but hospitalization in Santa Barbara. She’s on Blue Cross or Shield now, only because she’d just moved to Boston (where they can’t refuse you with a pre-existing condition — otherwise, it really would’ve been scarey). Thank you Massachusetts! Still… so much to deal with just with health issues, not to mention the money game. Thanks for posting this. My daughter doesn’t have a pump yet. She’s at Joslin and they want to wait a year.
Barbara,
Sorry, your comment was stuck in the spam filter.
I’m so sorry to hear the troubles your daughter has gone through. Anymore, I’m surprised to hear doctors waiting to put Type 1 patients on the pump. I read a lot about Massachusetts’ health care legislation, in the past few years. I’m glad to hear a story from someone who has gotten at least some benefit from it.
All my best for you and your daughter!