You’re not the boss of me!

Argh.  I have a love/hate relationship with insurance.  Love it because w/out it, well, I’d be selling my kidney and firstborn to pay for my diabetes care.  However, that being said, even with insurance, diabetes is expensive, man.

One of the perks for buying my new pump and CGM early on in the year and all at once was that I have met my out-of-pocket max for the year.  Hello, 7 months of lower diabetes costs!  Woohoo!  I called my insurance company to see what exactly was now covered at 100% and was told “all diabetes supplies.”  I clarified with her, “So, pump supplies, CGM sensors, test strips, correct?”.  It was confirmed, yes, these things are covered.  Parrrrrrty!

Imagine my surprise when I went to the pharmacy today and I was asked to pay for my test strips.  Now, this isn’t a $20 co-pay, it’s close to $100 for a one month supply.  The young lady at the pharmacy assured me that they ran it through my insurance/prescription coverage so I paid and told her I’d take it up with them.

I called my insurance company first who connected me with the prescription folks and told me yes, my strips are covered at 100% if I use Accuchek.  I use OneTouch, and they are not covered at 100% under my plan and despite meeting my out-of-pocket expenses, I still have to pay the $100/month.  The way she made it sound was that Accuchek strips are covered 100% all the time, no matter if the out-of-pocket max has been met.

I told her this is ridiculous and she needs to give me the phone number of whomever I need to speak to regarding this.  I have left a voicemail and am looking forward to receiving a call back.  It just makes no sense to me that my pump supplies are covered yet the test strips for the meter that talks to my pump are not.  Does.not.compute.

It makes me pretty angry that some random person gets to decide what is covered and what is not and make decisions about MY medical care.

Wish me luck when dealing with the insurance company!

5 thoughts on “You’re not the boss of me!

  1. Ugh, I feel your pain. If I want to use the ones that talk to my meter they cost more and I get fewer, if I get the one touch they are cheaper and I pay almost nothing. Between insurance and medical companies I really wish the decision makers could walk in or shoes and make better choices so we don’t have to spend the amount of money we do on our diabetic care. I feel like what I pay is enough to buy my own private island!

    • haha, well, I apparently get accuchek for free but need one-touch. We should set up a website where those of us with Diabetes can trade, ha!

      It’s so frustrating!!!

    • haha, well, I apparently get accuchek for free but need one-touch. We should set up a website where those of us with Diabetes can trade, ha!

      It’s so frustrating!!!

  2. I’ve been through something like this… you may get the 100% coverage if you treat it as Durable Medical Equipment through your MEDICAL plan, but that doesn’t apply if you purchase it using your PRESCRIPTION plan.

    Find out who your medical plan will allow you to buy from (it’s probably got to be an in-network provider; Edgepark is who I’ve used lately) and see how it works that way….

    Make sense? I don’t think it’s supposed to, but that’s what works for me..

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