Moments of Wonderful

…rather than a lifetime of nothing special. A diabetes blog.

Moments of Wonderful - …rather than a lifetime of nothing special. A diabetes blog.

Cut a check

Living with diabetes, I am not sure if the insurance woes will ever end.

On my last insurance, my deductible was high enough that it was difficult to reach within a benefits year and I had to pay quite a bit for pump and CGM supplies. On the other hand, the administrators of the plan had developed a deal for the members with diabetes on the non-DME items and I did not have a copay on items such as insulin, test strips, and lancets. There was also no limit on the quantity of insulin or test strips that the doctor could prescribe (more on both sides of this below).

On my new (since February) insurance, my deductible is much lower. In fact, one DME order met the deductible and I am just paying my percentage for DME supplies for the rest of the year (especially once Edgepark gets its act together with billing). On the other hand, I have run into nothing but problems with my other diabetes supplies.

First, my brand of insulin was considered a step therapy, meaning I had to fail on a preferred (cheaper) brand before they would approve the other brand. My endocrinologist and I worked on this issue, and I have precertification for the next year to get the insulin that works best for me.

some of my favorite results

Just some of my favorite numbers. Not a representation of ALL results.

Next, I had to stop using the iBGStar because the strips were not covered at all on the insurance plan. I really enjoyed that meter and the ability to use the app on my phone and carry around a little bit less every day. The only downside was the lack of compatibility with Diasend. The local Sanofi rep told me not to hold my breath but I do keep an eye on my coverage every few weeks in case anything changes.

Most recently, I needed to get my first refill on my test strips. I was able to last this long because I refilled everything I could on the very last day that I was covered on the previous plan and received three months worth of my supplies. The first time I tried to fill this prescription there was some confusion on one of the notations and the pharmacy couldn’t figure out how to fill it. I went back to my doctor’s office to get a revised prescription and then waited as the pharmacist entered it into the system. We find out that while the doctor wrote it for X amount, insurance will only approve it for Y amount. After a short debate about how many boxes that equals – basic math FTW – I finally got my monthly supply.

I do understand why insurance companies have put a limit on test strips quantities, but I also believe that the amount that the doctor wrote the prescription for is a more accurate representation of my daily use. After all, we DID have a conversation about my management before he wrote it. It is frustrating to me that insurance companies cannot trust doctors and patients not to abuse the system, and feel that they need to have these limits in place. I am thankful to have a medical team that is willing to work through all these hassles and help me maintain the management that works best for me.



Passive aggressive side note: I find it interesting that the insurance company that has caused these problems is the same company that is so proud to sponsor a yearly symposium for people with diabetes for a national organization. Seems to be a bit of a disconnect for them about really helping people living with diabetes in this community.

  • katy says:

    I like #70 too, but I always feel like I’m not supposed to.

    Good luck with Edgepark! Remember, used breast pumps can not be returned.

    June 25, 2013 at 7:57 am
  • Tammy says:

    Yet we, the patient, are labeled as NON-COMPLIANT. I think that label needs to be put on the insurance company. Frustrating.

    June 25, 2013 at 11:16 am
  • Lisa says:

    My doctor wrote the prescription for me to test 3 times a day. But I’m a type 2 who goes low on metformin. She wants me to have enough to make sure to cover that, so she wrote the prescription for 150 strips a month. My insurance company says since I’m only testing 3 times a day, I can only have 90 strips a month. But since the strips come in bottles of 25 I can only have 75. They can’t allow the 10 extra strips in the fourth bottle. I can’t even get enough strips to test three times a day. On top of that, the copay is really high. I gave up and went with the cheapest strips that I can get, even though the meter is a no bells or whistles model. I recap the out of pocket money by claiming on my HCSA. Still, that is my money. I am paying myself back. I write them hate letters every month.

    June 25, 2013 at 2:00 pm
  • Christina says:

    Ugh insurance. Yea Insurance. Ugh insurance. Yea Insurance. I swear its a loopy loopy ride. Sorry yours isn’t always playing fair. I do find it so very upsetting when the insurance seems to think it knows better than the doctor. (In my case they are the same company so it really ticks me off – plus I don’t think its great to go to a doctor employed by the same company that provides insurance but whatever.

    I hope your company sees the light with the IBGStar meter soon and Im glad you are able to get the insulin that works best for you. Not all insulins work the same in all people so its important to have a choice.
    Hugs.

    June 25, 2013 at 2:51 pm
  • Scott K. Johnson says:

    I hate all of the extra work involved in navigating insurance issues. Diabetes is hard enough — we don’t need all that extra stuff to deal with. Can I get an “AMEN!?” 🙂

    June 25, 2013 at 10:05 pm
    • Sara says:

      AMEN! 😛

      June 25, 2013 at 10:11 pm

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