A drive in the countryside ended very badly for one of my patients several years ago. She was wearing the old Dex7+ CGM on her waist while riding on the back of a four-wheeler. The receiver's notoriously crappy clip failed and the CGM went flying off into the woods, somewhere between points "A" and "B," never to be found again.
I got a rude reality check when I helped her file the paperwork for a replacement with her health insurance company. Replacement for lost or stolen durable medical goods was an uncovered benefit. Not only would her health plan not replace the wayward CGM receiver, they also refused to get her a new one a year later when the warranty was up. As my patient had lost her first receiver, they were never obligated to replace it. Ever. To this day they refuse, despite her hypo unawareness and frequent ER visits, to get her a new CGM.
Welcome to my clinical world, where I not only deal with the health implications of using medical devices, but also issues that my patients encounter in actually using these devices out in real-life situations.
Unlike cell phones, medical devices don't have their own specific insurance policies to be covered and cheaply replaced within hours of going missing, getting stolen, dropped on pavement, run over by Humvees, or flushed down toilets. No, there aren't the same kind of "what if" options for whatever the universe rolls out.
If we can protect our metaphorical lifelines, why can't we do the same for our literal lifelines? It's a question that defies logic, so naturally we decided to dig into it.
We users end up depending on the kindness of strangers, i.e. the makers of these devices themselves. And what policies do the leading D-device vendors have in place to help patients here?
Animas: JnJ Global Communications Manager Kaitlin Meiser says the Animas Ping system is only covered by a limited four-year warranty against manufacturing defects. Like most pump companies, if yours craps out in a covered way, they'll replace it with their choice of a new one or with a used, re-certified unit. To be clear, there's no coverage for "accidents, negligence, misuse or abuse by the user or any other third person." So don't get mugged wearing a Ping. And again: You drop it, you bought it.
Insulet: The makers of the OmniPod passed me off to Brian Baxter of their PR firm, Lazar Partners, who thanked me for reaching out and said, "Insulet doesn't offer such insurance but the Personal Diabetes Manager (PDM) does carry a four-year warranty that is in line with requirements from most insurance providers." This from a firm that brags on its website that they help their client develop, "clear and distinct messages." Huh? So much for being clear... which is really unfortunate given that the OmniPod PDM is more likely to be left somewhere by mistake than another D-device that's actually connected to the body. On the company's FAQ page, one of the questions specifically offers a response to the "lost PDM" issue: "Our experience has been that very few people lose their PDM. However, if you do lose your PDM, please contact Customer Care immediately to purchase a replacement. In most cases you will receive your replacement within 24 hours."
Medtronic: According to Public Relations Director Amanda Sheldon, the company doesn't offer insurance for lost or stolen devices, but "recommends that customers explore coverage options with their homeowners insurance." More about that option in a bit. Sheldon then helpfully reviewed the type of damage that's NOT covered under Med-T's standard warranty, including using non-Med-T reservoirs or infusion sites, submersion in water, physical abuse, dropping the pump (that never happens, right, People?), or "Force Majeure," which I had to look up on the Internet. Turns out it has nothing to do with dropping your pump in a pile of manure. Rather, it roughly translates to "force of nature" and is used in contractual language to exclude damage from natural disasters and the like.
Tandem: You might think that a company with ground-breaking technology might test-drive a ground-breaking business model too, but you'd be wrong. Steve Sabicer, of SocentPR, tells us that, "Tandem Diabetes does not offer insurance if your t:slim is lost or stolen." He adds that, "Many homeowners or renters insurance policies offer riders, like in the case for jewelry." Well, a number of reviewers have called the snazzy touch-screen pump jewel-like, after all.
Asante: Makers of the new Snap insulin pump appear to be at least considering thinking outside the box the insulin pump comes in. Vice President of Marketing Ken El-Sherif tells me, "The short answer is no, we do not offer insurance for lost or stolen devices," but goes on to say, "It is something we are consider doing in the future." So Asante might just snap up the opportunity to be first among device makers to act more like a consumer device company, and less like a medical device company.
Roche and Dexcom didn't respond to inquiries, but overall the bottom line is that makers of insulin pumps and CGMs feel that their responsibility ends with regular, warranty-type issues. Never mind that our lives depend on these devices 24/7.
So the pump makers have passed the buck to the nation's homeowners insurance providers. But are you in good hands with Allstate? Like a good neighbor, is State Farm really there? Is Nationwide really on your side? Naturally, I decided to find out.
Allstate's Justin Herndon in their media relations & issues management team, says PWDs are indeed in good hands with Allstate. Maybe. He says, "Legally prescribed medications as well as medical equipment are covered under our homeowner policy. But he went on to point out that, "If the medications and/or medical equipment are expensive, it may be a good idea to review your personal property limit with an agent to make sure (they) are high enough to cover what you have."
Farmers Insurance does not cover insulin pumps as part of their homeowners policies, according to Mark S. Toohey, head of media relations. State Farm never responded to our inquiry. I guess my good neighbor is on vacation this week.
On the other hand, Nationwide just might be on your side. According to Jarrett Dunbar, their national communications consultant, insulin pumps or CGM receivers are treated like any other personal properly under most of the firm's homeowners policies. But oddly, "Nationwide would cover for theft and damage caused by perils named in the policy, but not for breakage or mysterious disappearance." Ya gotta read your policy, and then choose your words carefully if submitting a claim.
But it gets even more complex. Some policies will only cover loss, damage, or theft that occurs inside the home. If you are out in the world, you're screwed. And even if you've got a policy that might cover your other personal property in motion, don't assume it will cover your pump. All kinds of specialized equipment is exempted from the personal properly section of homeowners policies. You really need to talk to your agent, and you'll most likely need a rider or a schedule (special provisions for individual high-value items).
Yup, insurance experts seem to agree that the safest way to ensure that your D-gear is covered is to make sure it is "scheduled," which translates to a list of property that's specifically covered by the insurance plan. So long as the scheduled items don't exceed the coverage limits, there's generally no additional cost involved. It's like a contract within a contract. But for the ultimate protection on a homeowners policy, you should get a "rider" on the policy (a mini policy that "rides" on the back of a larger policy). It will cover something very specific, but it will cost you more, of course.
Since most policies don't actually cover your losses and require deductibles, you'll also be paying as low as $500 but as high as a couple thousand dollars. So if your basic policy doesn't cover your D-gear, you'll need to weigh the cost of a rider, taking into account the monthly costs, the deductible, and the covered types of losses, and see if the math makes sense to you.
Wait a sec, you say: thanks to the high cost of diabetes care, I can't afford a home. I rent. Well, actually, renters policies are very much like homeowners policies, only heaps cheaper because they don't cover the cost of the building if it burns to the ground. Renters polices cover both liability and personal property when you don't own a home, meaning that you have the same crap shoot in getting your D-gear covered that the homeowner does. Um... you need to talk to your agent.
And of course, most renters don't have renter's insurance, so what's the non-homeowning, non-renter-insured PWD to do?
Commercial D-Gear Coverage
If you use a search engine to look for "medical device insurance," you'll get hundreds of companies ready, willing, and able to insure your startup medical device company against those nasty liability issues. But I couldn't find any coverage for individuals using this route.
Then I got to thinking. Long before diabetes came to live with my family, I worked as a professional photographer. Good camera gear was expensive, and my daily work kit set me back about the price of an insulin pump. But it was fairly easy for me to find a commercial insurance plan for cameras, which face all the same daily hazards that insulin pumps do. So just for the hell of it, I decided to ask one of the many companies that still insure camera gear how they might feel about covering an insulin pump.
I chose an online outfit called insuremyequipment.com because I liked their name, and because they would cover loss or damage from things as far-ranging as theft, earthquake, acts of terrorism, falling objects, lightning, explosion, windstorm, hail, and mundane dropping. My kind of outfit. No manure fears here. My inquiry caught them a little flat-footed, as they had never considered it before, but they were open to the idea. Program Director Michael DeFazio wrote me, "I just asked our program's underwriter what he thought about including insulin pumps in our program. I don't see why there would be any problem." If he gets the nod from upstairs, he estimates that coverage for an $8,000 insulin pump would cost $433 per year. That works out to a little over 20% of the cost of the pump over the typical four-year warranty period.
When it comes to insuring the uninsurable, Lloyds of London is historically the place to turn. Claire Sheahan in Lloyd's Market Services points out that they're an insurance market rather than a single insurer and it's best to talk with a licensed broker in a particular country or state. But the truth is that Lloyd's of London actually does insure insulin pumps. They're the underwriters for Insurance 4 Insulin Pumps, a British firm that, so far as I can tell, are the only firm in the world dedicated specifically to insuring insulin pumps. The catch? Ya gotta be a UK resident. Why are the Brits more civilized than we are?
Probably because the UK's health insurance system actually owns the pumps that it supplies to patients, and the government requires the PWD who gets a pump to maintain a £3,000 (approx. 4,800 U.S dollars) insurance policy on the pump they've "loaned" you. That's a very different model than our system, in which your insurance company pays for the lion's share of the pump and then you own it.
What it comes down to is that even without a service that seems so obvious to many of us, there are still numerous ways to insure a pump or a CGM today. It might be covered on a homeowners or renters policy that you already have. If not, you may be able to add a schedule or buy an extra rider. If that fails, it seems possible that you could purchase a specialty policy, similar to the ones professional photographers use to protect their camera gear.
It may not be cheap, but it beats having your gear lost in the woods, never to be replaced again. Plus, looks to me like there's a real opportunity here for some enterprising entrepreneur to start up a new D-device insurance service. Any takers?