Open Enrollment Season 2016

Open Enrollment Season

Yesterday that good ole’ packet about open enrollment came in the mail. For the past 3 years, my wife and I have not changed our plans and I don’t plan on doing so again this year, even with the new addition to the family. The only part about open enrollment season that worries me is, how are my expenses going to change in the next year.

In 2013, I used Apidra because it was $50 for a 90 day supply.

In 2014, I then switched to Novolog because Apidra went up to $150 for 90 day supply and Novolog dropped to $30 for a 90 day supply.

In 2015, I switched to Humalog because Apidra stayed at $150 for 90 days, Novolog went up to $150 for 90 days and Humalog dropped to a whopping $12.50 for 90 days worth of insulin.

So, 3 years, 3 different insulins all because the costs changed dramatically. I never know going into the next year what insulin I am going to be using.

The same goes for my test strips.

I have gone back and forth between One Touch and Contour strips for 3 years because of the large difference in costs. It would be nice to be able to choose which strips and insulin I want to use based on my personal preference and not on what my wallet can afford.

So, just for my own curiosity, I wanted to see how many others have had to change their insulin and/or test strips every year based on the difference of costs from year to year.

Have you had to change insulins from one year to another based on different copays?

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Have you had to change test strips from one year to another based on different copays?

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Medtronic Diabetes Customer Service

My Denial and Approval Process of the Minimed 530G

As some of you may know, I was offered a free trial of the Minimed 530G (Disclosure Post) and have been using it ever since. Once the trial was over, I made the decision to stay on the 530G system and the process of getting it covered by insurance was about to begin. And it was a long process.

After the first submission to UnitedHealthcare, it was denied. I received a phone call from my local Medtronic rep, as well as the marketing team at Medtronic who was working with me throughout the trial process and my endo. They all explained to me that this was a very typical response the first time around, but that they were going to submit a letter to the insurance company to get an approval the second time around.

However, the team already knew that the second claim was going to be denied as well. They explained to me that usually it takes three attempts and then after that third attempt is when it finally gets approved.

Long story short, that’s exactly how it happened.

Normally, I would have been pretty upset and irritated that every time I received a letter from UHC, it was a denial letter. But, for the fact that I already knew I would receive these denial letters, it made it a lot easier. Also, the fact that I just had to sit back and do absolutely nothing and that my healthcare team and Medtronic themselves were working for me, was pretty comforting.

After that initial denial letter, I was sent the following PDF from the Medtronic team that outline the documents needed from your healthcare professional and the appeal process and what you can do to speed up the approval process.

Download the MiniMed® 530G with Enlite® Coverage Tool Kit

Now that the process is over and the system was approved and that I have received the product in the mail is very exciting. I can’t wait to get it all set up and start using my own instead of the trial demo product.

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A Deductible and Double Co-Pay Later

My saga with OptumRX is over, at least for this go round. As my previous post mentioned, I’ve had a very difficult time getting my insulin re-order. As an update to the previous post, I have received all the insulin that is needed.

I ran out of insulin and needed to go Target in order to fill my retail prescription because the mail order did not ship in time. I decided I would pay the $100 deductible because I needed the insulin, however when I went to pick it up, they couldn’t process the order because it said I just had the mail order filled.

If you’re getting confused, sorry, but this is how it went down. The pharmacist had to call in for an override which took another 15 minutes.

Finally, I had my insulin from Target which is a one month supply, now I just needed my 90 day supply delivered.

I did not get the delivery the next day, so I called and the RX was still being processed which I don’t understand how it takes that long when I had a RX on file, but just ran out of refills. And why does insulin need refill limits anyway, it’s not like I’m going to stop using it any time soon, but that’s a different story for a different time.

I received my delivery of insulin yesterday so I am good to go for insulin for the next 4 months. Which means hopefully I won’t have to deal with Optum for another 4 months.

Over the last 12 months I have had a mail order get delivered to wrong address, test strip order be delivered with half of the 3 month supply damaged and the test strips on the bottom of the bag, this fiasco, Humulin N delivered instead of Humalog.

And that has all been with OptumRX. To say that they are probably the worst mail order pharmacy is an easy choice.

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Oh OptumRX – Why Must it be a Hassle

As you may remember, I went about 18 months without insurance.  During that time I had to buy strips and insulin out of pocket and I also received a lot of items from people throughout the DOC because of how awesome everyone is.  One thing that I didn’t have to deal with during that time was insurance companies and mail order pharmacies.

Since I getting insurance back after getting married in July, I’ve been dealing with OptumRX as the mail order pharmacy and it has been nothing but a nightmare.  I really hate having to complain about companies on the blog, because I want to keep things positive and not just reflect on the negatives, but some times, you hit a boiling point and something needs to be said.

In just over 6 months of dealing with OptumRX I have had the wrong type on insulin shipped, the correct insulin shipped, but the wrong amount, having to change my password everytime I login online, prescription refills not being listed on the website so I have to call and wait on hold, 3 faxes from doctor before they finally “received” it, and now… this.


Yes, that is how my test strip order was received.  This is the order that took almost 3 weeks because they were not receiving the fax from my doctor. I did run out of strips and was using some leftover Contour strips that I had during this time period, which is primarily my fault for thinking that I could get more strips within 1-2 weeks. I was excited to get my first order of the Verio strips so I can continue to use the meter after I only had 10 trial strips to begin with.

This isn’t just a full blown bash against OptumRX.  I did call them right away and after speaking with 4 different people, they told me that they would send me replacement boxes with a return label to return the damage ones. I was told, “we will just ship them regular mail because some of the boxes weren’t damaged.”  Even though that statement is correct, I don’t know if it’s just me, but when you screw something up because of poor packaging, I shouldn’t have to wait another week to get it back.

All in all I can’t stand having to pick up the phone to call OptumRX for something.

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Humulin N Mistaken for Humalog

Yesterday I posted about the excitement that I had about ordering and receiving my first 90 day supply order since having insurance for the first time in 15 months. However, I also had to add an update because after coming home and opening the box, there was 3 vials of Humulin in this box.


20130919-171350.jpgI started thinking about why their would be Humulin N in this box and not Humalog, so right away I called the insurance company. They told me that the RX they had on file that the doctor faxed over was for Humulin N, 10 units a day, which meant 3 vials for a 90 day supply. What is this? I’ve never used Humulin N in my life. In fact, I didn’t even know what Humulin N is!

So I asked OptumRX what the process was to return this insulin and to get my $25 back for this 90 day supply because I will never use this insulin and it’s just going to go to waste. Well, since they shipped the insulin that the doctor faxed over, they cannot refund the money and they cannot accept the insulin back as a return. I mentioned that it was a doctor mistake and I’m not even using Humulin so it’s not an actual doctor’s order because I don’t use this stuff, never have.

Their answer, “Sorry, sir, we apologize for the inconvenience, but we cannot refund the $25 or accept the insulin back as a return”

One day back with an insurance company and already the hoops, loops, obstacles, and BS has started. I also mentioned yesterday that I will never complain about insurance or pharmacies again because I have lived without having them, so I am completely grateful for this and the $25 loss is well worth it, as long as the correct insulin is ordered and shipped.

I called the doctors office this morning and explained the situation. The doctor’s assistant is the one who faxed over the RX and there was a bit of confusion….so, let me explain.

During my last visit, we discussed ways to try and cut out these highs in the morning. Here’s an example of one, I woke up this morning at 124 @6:30 a.m. I fell back asleep until 9:30 and my blood sugar was 325. That’s it, no food, no coffee, nothing, just simply waking up increases my blood sugars crazy high. So, my doctor recommended taking 10 units of Humulin N at night before bed to try and stop those lows.

There was the confusion, I guess.

Doctor’s assistant saw the visit notes and saw Humulin and did not see anything about Humalog, because I was on Apidra, but it’s too expensive right now and went with Humalog. Even though I told the receptionist Humalog, and I know she didn’t get it wrong because she’s probably the best doctor’s receptionist I’ve ever had before.

Bottom line is that the issue is fixed….I hope. My credit card was charged another $25, so I’m assuming I should be getting an email later tonight about the order shipping and hopefully will get it tomorrow. If not, it’s back to the doctor for a sample vial of insulin to get me through the weekend.

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15 Months of Waiting for a 90 Day Supply

It’s been approximately 15 months since the last time that I was able to go to my mailbox and pick up a 90 day supply of insulin from the insurance company, and damn it feels good. It felt great yesterday to call the insurance company and set up my mail order account with OptumRX, which this is my first time dealing with them, I’ve previously dealt with Medco with United Healthcare.

The customer service rep answered all the questions that I had about my new insurance and the costs and it was a very simple process to set up my account and get my first order submitted. Called the doctor and had them fax a prescription which I figured would take several days for it to be input into the computer and then another day for the order to process. That was not the case. I called my doctor around 10 a.m. and I received an email last night around 7 p.m. that my order was processed and had a tracking number. That tracking number showed that the package was already picked up and headed my way to south Florida.

The insulin pricing was a bit different then previous insurances that I used in the past. And insulin in a vial vs insulin pens were different as well. For example, the Humalog insulin vials were a tier 1, but the Humalog insulin pens were a tier 2. The Novolog vials were tier 2 and so were the insulin pens, but the insulin pen refills were tier 3. Apidra of course was a tier 3.

Just for my own curiosity, is Apidra NOT a tier 3 for any of your insurances?

Going from what I was paying out of pocket for insulin, which could have been a lot more if it wasn’t for some of the awesome people in the DOC, to only having to pay $25 for a 90 day supply, I cannot find words for the way it feels.

Next up is test strips. All of the supplies are covered under my medical and not pharmacy, so that’s a whole other story. The new year for insurance starts in November, so why waste money on a deductible now, when it will just need to be re-paid again in a month and a half. But that also means I have to stretch out the life of the current strips that I have.

No matter what, I will never complain about an insurance issue, the costs of supplies or a deductible or anything! I hope that I can eventually help others as much as people helped me get through this tough time.

***Update*** I wrote this post before I opened up the package. I received the package and went to Starbucks to write this post.  Upon opening the box when I got home, the package contained 3 vials of Humulin N.  I use 5 vials of Humalog a month, and have never used Humulin, so this is a big mistake.  Then I remembered that during my last appointment two weeks ago, I spoke with my doctor about possibly using 10 units a night of Humulin to help with the morning highs and that’s where the confusion may have came in.  So, although the pharmacy did not make a mistake and I have been billed for the $25 for the insulin that I will never use, I can’t really complain about them.

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One Week and Counting

Less than one week away from getting insurance again.  I am super excited and haven’t been this excited in a long time.  It’s been a struggle without the insurance and I would never want to have to live through it again.  My A1C has gone up since I haven’t had insurance and easy access to supplies, but luckily the DOC pulled through and really helped me.

I can’t wait to be able to help others in the DOC out.

September 1 just please hurry up and get here!

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Re-United with Healthcare

Re-United with Health Insurance

As of September 1, 2013, I will be re-United with health insurance.  See what I did there? United Healthcare was my former health insurance company before the whole COBRA fiasco, and now United Healthcare is my insurance company again.  I am super excited to have this full insurance again.  I can’t wait to order all of my supplies and not have to worry about things not being covered and paying for everything that I need out of pocket or nagging my doctor to provide me with free samples just so I can get by.

I will be on an HMO plan until October which is when open-enrollment is, but even then, I don’t think I will switch to a PPO because it is nearly $700 per pay period, so in total around $1,500 a month for just Amanda and I.  To me, that doesn’t make any sense for the fact that Amanda works for a government organization, but it is, what it is.

For all of those that helped me along the way, thank you.  I don’t think that I can ever pay any of you back for how much it really meant to me, the best that I can do is now try and help others who are in need of help.

Thank you all once again.

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You Down with PPO or HMO

First, I want to apologize to everyone for creating an earworm for the rest of the day and having you sing Naughty by Nature…not cuz I hate ya…anyway.

Since I am a newly married man, which it is still weird saying my wife instead of girlfriend or fiance, I am finally able to be put on her insurance.  I won’t officially be added for about a month because of the time it takes to get the marriage license, change her name, and then be added to the insurance.  Then, even after I am added to the insurance, I still don’t know how long it will take until I can actually use the insurance.  That’s the big question.

However, before that big question comes about, theres an even more important question, which plan do I choose?

When I was a single guy and had my own insurance, there was no question, I was going with the PPO plan.  Now, with having a spouse on the plan, it more than triples the monthly cost of the insurance premium (approx. $680/mo).  If I went with the HMO plan it is only approx. $225/mo.

So, obviously, this is where I need your help.  I was told in the past when I had to choose my first insurance plan with diabetes to never go with the HMO option. “If you have diabetes, you should always have a PPO”  I don’t know if that is the right advice or just some BS by that particular medical professional, who maybe wouldn’t be covered under the HMO plan.

Have you had any terrible nightmares with HMO plans with diabetes?  Is it really the worst insurance option for someone with diabetes?  HMO is still better than no insurance at all right?

Please let me know your thoughts and please share so I can make the most educated decision.  A difference of $4,000 a year is definitely a big deal.


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Almost Out of Strips

So, as you all know I have been without my full coverage for a while now.  Which means that I am paying out of pocket for test strips, pump supplies, insulin, etc.  It’s now time to purchase some more test strips.  I thought that I was good for another two months, but, once again, I left two empty boxes of strips in my inventory cabinet and thought there was strips in the boxes, but there wasn’t.

There are a lot of purchasing decisions in life that can be tough, a car, a home, deciding to buy a new 27″ iMac!  However, these type of purchase decisions is not very tough because there is not much of a choice.  I have been lucky to have an endo that is so willing to give me anything that I need, but there is only so much that I can take from them without feeling like I am taking from people with smaller incomes that need the samples more than I do. (more…)

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