Durable Medical Equipment

There are some things that should really be covered generously by insurance companies, such as a prosthetic limb, for example. It would be kind of mean and unfair to expect someone who has lost a leg to pay a lot for their fake replacement. Right?!?

This category of medical supplies is called durable medical equipment.

"Is that exactly what it sounds like?"

Yes. Wheelchairs and heart pumps and insulin pumps all fall under this designation. The DME coverage could make a huge difference in a person's life. Mine, for example.

Coverage 1: DME covered at 100%. "Great!" you say. Not so fast. When I further investigated this, I discovered that neither the pump, nor any of the supplies needed for it, where categorized as DME. This was under my Harvard Pilgrim plan through Brandeis University, so I can give credit where it's due. This would mean that I could either shell out the money or go back to shots, which were covered under prescription benefits. This plan also had a $2000 annual cap for Rx benefits, so I would only be covered up to that amount of supplies (what insurance pays for the supplies).

Coverage 2: DME covered at 80%. Mind you pump supplies run $500-700 a month, plus all of the other for insulin and test strips ($25 each). Kaiser Permanente regular coverage through the Jewish Federation of the San Francisco Bay Area.

Coverage 3: DME covered at 100% as long as the provider is in network. This means I have to find a company that supplies insulin pump supplies in the DC/northern VA/MD region, as designated by CareFirst (BCBS company). CareFirst was unable/unwilling to help me find a supplier. They did refer me to the website where you can search for medical supplies by zip code. After calling a dozen medical suppliers I stopped when one representative laughed at me: "Nobody carries insulin pump supplies!" Here's the catch: if I can't find an in-network company, I can go out of network and be covered at the in-network rate (100%), but I have to be right. They could tell me I'm wrong and I'd have to keep looking for the elusive in-network provider. Otherwise, out of network is covered at 80% after meeting a $500 deductible. (I pay the first $500 after which CF covers 80%).

Not that I've ever had a CHOICE of coverage, but it's still interesting to think about which option is the best or least crappy.