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.
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.