Medical supplies

Despite the fact that Izzy has three medical insurances (one private PPO and two government/state insurances), we have been paying for all her medical supplies out of pocket. It has been more fiscally beneficial to buy them on various Internet sites and pay full price than to pay the co-pays billed out by the medical supply providers. There is no restriction on the selling price of medical supplies and medical equipment; therefore, the markup on them is comparable to diamonds, around a 1000%. But while I can live without diamonds, I cannot live without medical supplies. Actually, I can, but my daughter can't. 

If we didn't have private insurance, the two state/government insurances would pick up the cost of Izzy's medical supplies, but since we have a private PPO, the supplier has to bill our primary insurance first, who may or may not pay for these items. Even if your insurance coverage includes medical supplies, not all medical supplies are necessarily covered, plus there is a designated amount that is payable for a specific item. 

While I usually think that insurance companies are in cohorts with the devil, I can't fully blame them for this policy of approved amount, considering the ludicrously high claims they receive from the medical supply providers. Understandably, they don't want to pay 500 dollars for something that the provider bought from the manufacturer for 50 dollars. Unfortunately, I don't have the luxury of setting an approved amount and I am liable to pay the amount that insurance doesn't cover. 

For instance, the approved amount for Izzy's mic-key button is $76.2, which might be a reasonable figure compared to the manufacturer's price, but a meager help when it comes to the $250-$300 charged by the medical supplier. Now, you can buy a mic-key button from online suppliers for as low as $135 +tax and shipping, and they still must make profit on it, mind you, otherwise they would sell chocolate or rubber duckies. Therefore, it is cheaper to forget the prescription and the insurance coverage and pay the full price online, rather than go through a medical supplier and pay the difference between the approved amount and the supplier's price. 

I have been told by a Medi-Cal representative that CalOptima (Izzy's state insurance) would pay for her gastrostomy tub, enteral supplies and whatnot, they would just need some paper work and a denial letter from our private insurance. The representative also told me, that if I order the supplies through a company or specialty pharmacy, they would take care of the paper work and the billing. So I gave it a shot and sent the prescription for Izzy's mic-key button, suction cups, and whatnot along the required paper work to a specialty pharmacy on Tuesday. They have been trying to figure out whether they can place the order for our supplies ever since. 

During our last conversation, the representative triumphantly informed me that she has finally got a hold of our primary insurance and since we met our deductible for this year, we can go ahead with the order, we just need to provide a letter of medical necessity and I need to fill out some paper work and send it back as soon as possible. I asked her, if CCS or Medi-Cal would pick up the co-pays and deductibles that our private insurance didn't cover but she wasn't able to tell me that. She thought CCS wouldn't but Medi-Cal might. I guess, since our private insurance didn't reject the claim and pays a part of it, Medi-Cal doesn't necessarily kick in? 

"So I might end up with a large co-pay, if Medi-Cal doesn't pick up the difference, right?"- I asked the representative. 

"Yes, we would bill you and you would be absolutely liable for the co-pays."

"I understand that I am liable for the co-pays, but I'm thinking, if Medi-Cal is not covering the difference, it might be more beneficial for me to continue buying these supplies on my own and paying for them out of pocket."

"Yes, it might be more financially beneficial for you"- she agreed. 

"Well, it's just a bit ridiculous that we have three insurances and I'm better off not using them."

Silence.