In Episode 004 of my VLOG, I decided to express my thoughts on the ACA and Pre-Existing Conditions.
Please comment, like and share and don’t forget to subscribe.
The summer of 2016 is one that was something that I would love to forget when it comes to my diabetes. I was using a temporary insurance and this temporary insurance did not have any prescription, well it did, but if you call getting your insulin at 10% off retail costs coverage, than ok.
I was using Novolin R during this 90-120 day period. I was using this because it was affordable, at only $24-$27 per vial at Walmart. This “insulin” was affordable but it did not work. No matter what I tried, I could not get my blood sugars to act anything like they do when I’m using Novolog.
I would take 30 minutes before eating and still shoot high. I’d not know that I was going to eat soon, so I’d end up taking the insulin over 5-10 minutes before hand and my sugar levels would sky rocket. I would take a large amount of insulin to correct a high and it would do nothing, so I’d take more, and then 6 hours later, in the middle of the night, I’d drop down low and need to correct with middle of the night Skittles and OJ.
September 1 started my new insurance that allowed me to pay $50 for my 3 month supply of Novolog.
I had a feeling that my A1C was going to be pretty bad (and no, I don’t care about my A1C). I was right, it was the highest that it has been since I was diagnosed 12 years ago.
I have also lost about 15 pounds since I returned back from my summer trip, so I know that’s going to continue to help with my insulin usage. Which means better eating, more time at the gym, which both lead to lower glucose levels.
I know, the title sounds like some sort of bad ad copy for a mail order prescription company, but that’s not what it is. I used to get my prescriptions for oral medications filled at Target, but once they switched to CVS Pharmacy, I got out of dodge as quick as possible. I’ve written several different times over 7 years about my disappointments with CVS.
I decided to switch my oral prescriptions over to Publix pharmacy. Publix is a local grocery store in Florida. It is actually one of the companies that ranks in top 20 businesses to work for in the country. I switched because where I live, there is only a Walgreens and a Publix and Walgreens didn’t take my insurance, so Publix it was.
I loved how quick and easy it was to get my prescriptions there. There has never been a line to wait in, they call my doctor for any refills or updates needed, they deal with any insurance issues, they call me if there is an issue instead of waiting until I get there to pick it up, they text me when it’s ready, along with the exact price (my generics change every time so the costs vary depending on which generic they are using), and the staff is very friendly.
Because of this, I’ve actually decided to start getting my test strips and my insulin from them on a monthly basis as opposed to saving $20 and getting a 3 month supply. The mail order pharmacy that I had to deal with was always filled with insurance. If at anytime, I needed refills, or emergency orders, it would take “24-48 hours to process a new refill request, and then another 24-48 hours to ship out”, meaning that it would take a minimum of 2-3 days to get a new prescription or update to my insulin prescriptions shipped out.
I’ve now been using Publix for 3 months now and I absolutely love it.
It has been the easiest time in over 10 years of dealing with insurance and supply refills.
My wife and I have been covered under an insurance plan from her employer for a couple of years now. Since she is no longer working, we were able to still use the insurance, but in January, we were going to have to switch to COBRA and as we all know, it was going to be crazy expensive.
So, I decided that I was going to go out and get insurance for myself. Just to be able to say that felt so damn amazing. Thanks to the Affordable Care Act, I am able to go out and search for my own insurance and include my wife and daughter on that policy. The downside? I had never searched for health insurance before, so I was absolutely clueless where to start.
On December 15, because why wouldn’t I wait until the last day in order to get coverage starting January 1, I sat on the phone with Florida BCBS for nearly 3-4 hours trying to get an application in for a marketplace plan. I knew that I would be receiving a subsidy, so I didn’t want to get a plan directly through Florida Blue, but wanted a marketplace plan that was Florida Blue’s.
This took so long because I needed to have myself, my wife and my daughter all added into this application and added to the plan.
After several hours, I was done. I chose a plan, I knew how much my premium was going to be and everything was set. All I had to do was pay my premium before January 1 and I was good to go.
January 2 came and I had already paid my premium, so I called Florida Blue to find out what my member ID was because I had a doctor’s appointment on Monday, as well as my daughter. When I called, they couldn’t give me my ID # yet because it hadn’t been populated. Also, they told me that my daughter was actually not even enrolled on my plan.
I just about lost it. I had spent hours on the phone with Florida Blue confirming that she was on the insurance. There was nothing else Florida Blue could do, I had to go and call the Marketplace to make changes.
I finally spoke to someone at the Marketplace and they explained the situation that my daughter was on the application, however, was not added to the plan and that it was an error on their end. So, I had to spend 3 more hours on the phone with the Marketplace again to re-do the application, get my daughter added and then had to wait and speak to a level 2 customer service rep to get my daughter’s insurance backdated to January 1 as opposed to February 1 since I was doing this after the cutoff date. This entire process took nearly 5 hours on my Saturday.
I called Florida Blue back today in order to get my member ID because I need prescriptions and labs done. Finally, they had my member ID and I asked out of curiosity if my daughter was added…..and she was!!!!
It was the first piece of good news I heard from an insurance company in a really long time.
My advice to others who go to the Marketplace for the first time is ask a million questions, confirm things hundreds of times, get names, employee ID #’s, extensions, speak to managers, do whatever you need to do in order to ensure that your information is being handled properly.
After over 10 hours on the phone with insurance over 2 days, I think everything is good to go. Until the next phone call.
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.
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.
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.
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.
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.
I 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.
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.