Not a week goes by….

… without fighting with my insurance company.

Warning: this post is rather venty and may contain some adult language.  Parental Guidance Suggested.

For the past few months I’ve been in one battle after another with my insurance and/or pharmacy benefits company.  Luckily, everything went smoothly with obtaining my insulin pump and CGM.  However, there have been a few headaches that I’ve had to deal with that are really starting to piss me off.  As if we PWDs don’t have enough to deal with, but insurance makes us jump through hoops (of fire, it seems) to get things done.

Test Strips – My blood sugar meter “talks” to my pump.  Yay, Animas!  It’s a One touch meter, not some fancy unique brand that no one has ever heard of.  Well, my strips cost $95/month.  I’ve reached my out-of-pocket max for this benefits year (a perk to making major cyborg-living purchases!) so since they are classified as Durable Medical Equipment, they should be covered 100% for the rest of my benefit year.  Of course they weren’t so I called and was told they aren’t the preferred brand so if I want them covered 100%, I need to switch meters.  Pisses me off.  My pump supplies (remember, my meter “talks” to my pump) are covered, no questions asked.  So, fine.  I’ll switch meters and only use my meter remote when I will need to bolus from it (wearing a dress).  Worth it to save $$ and not a huge deal since I bolus from my Ping 99.7% of the time anyway.  I call to order my new meter (Verio IQ) and they are back ordered/recalled/they don’t like me so they won’t send me one/something.  So, guess who is on her last pack of strips and has to order more at $95 for a month?  THIS GIRL.  I am tempted to call and argue that they should cover this month’s worth of strips since it’s not exactly my fault that I don’t have my new meter yet.  But, I really doubt I’ll win that fight and frankly, I’m tired and don’t even feel like putting forth the effort.
Insulin – Previously, I used Humalog.  Was always covered with no problems.  Well, my doc switched me to  Apidra.  However, when I first got back on pump therapy, my pharmacy didn’t have any Apidra in stock so I used a vial of Humalog that I had to get started.  Worked fabulously.  But, my Endo wanted me to try Apidra so once the vial of Humalog was empty, I switched to it.  I feel like I’m not reacting to it as well as I did with the Humalog, so I asked to be switched back to see if this is the case.  This is all within the last 6 months.  Endo says, no problem, writes me a script for a 90 day supply of Humalog.  I mail it in to my mail order pharmacy and now my pharmacy benefits people are saying it’s not covered.  Something about the “formulary changed”.  Oh, I can get it, I just have to pay out-of-pocket.  So now I have to use a sub-par (for me) insulin because some higher up in some office decided that they weren’t going to cover my insulin.   Granted, it’s not like my control with Apidra is all over the place (if it was I’d be sure to appeal!), but I wanted to see if I’d do better with Humalog, like I think I would.
Dealing with insurance shit makes me rage.  I don’t expect anything to be free, but I’d at least like reasonable options when it comes to my diabetes management.  $1200/year just to test my blood sugar is outrageous.  Telling me what insulin I can and cannot use??  What the French is up with that?!
I don’t often get diabetes burnout.  Sure I’ll have a day here or there where I’m temper-tantruming against the disease.  But, man.  Insurance company burnout?  I have that 24/7.  I just don’t understand why it has to be so hard to make dealing with diabetes or any other chronic illness just a little bit easier with maybe a few more choices so we can make the best decisions for ourselves to manage this disease that we live with every day.
Maybe some day, this will be me.
33713653
Advertisements

10 thoughts on “Not a week goes by….

  1. So sorry to hear about your struggles with your supplies. Living with type 1 is so stressful anyway without all of this extra hassle.
    My Wife Sarah lives with type 1 and has a insulin pump with the extra sensor too, but in England, UK we don’t have any trouble getting supplies with our national health service.
    My prayers are with you through this difficult time! God bless.

  2. Keep fighting! They probably don’t realize that the cost difference is minimal. Ask for an exemption from the rule, and get a note from your endo if necessary. If your insurance is through your job, ask the benefits team there to help you out. Sometimes, they just don’t include things on the list to be covered because they don’t know that someone needs it. And since you’re only dealing with the provider so far, they may not even know about your issue.
    It’s such a problem dealing with all of this. Here’s hoping you win!

  3. Yuck! I can’t order more test strips until after August 11 and I’m considering ordering more off of Amazon because insurance won’t pay till then and there is no way that the supply that I have is going to last. I know I should call my insurance co and fight it out but I feel like it’s a fight I won’t win. I feel your pain, I’m sorry.

  4. I agree with everything you’re saying and leave you with just one thought: The reason why the insurance companies won’t let you make your own decisions about treatment: Because they don’t care about the long term health of the people who use their service, they only care about how many TRILLIONS of dollars they make for their shareholders.

    • I agree, someone is getting rich. I don’t expect anything for free, I understand that insurance is a business. HOWEVER, it’s very frustrating that they will all of a sudden change what is covered. I just want more reasonably priced options for those of us living with chronic illnesses. It’s not like I’m trying to get some experimental insulin covered, or something that is only manufactured or found in a small corner of the world, you know? It’s HUMALOG for pete’s sake!!!

  5. And to think you PAY for this “service”…

    It’s really frustrating to be forced to jump through all of these hoops. As if diabetes by itself wasn’t demanding enough.

    Hope that you are able to get some answers and supplies without too much trouble.

  6. Oh man, so sorry to hear about your issues with insurance. I definitely prefer when my meter talks to my pump. I’ve heard mixed things Apidra. Hope things are getting better with your insurance!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s