Thank You for Waiting 2 Hours: The Dark Side of ACA

Late last year, around October or so, my endo, primary care, my wife’s primary care, OBGYN, and endo all sent us letters stating that they were no longer accepting our MarketPlace insurance plan. This led us to searching for something new. Instead of just choosing a plan, we asked what MarketPlace plans they accepted. There was only one common plan, Ambetter from Sunshine Health. Don’t sound familiar to you? That’s because it’s a Florida based insurance plan, meaning, it can only be used in the state of Florida. That poses an obvious issue, but more on that in a later post.

My wife and I had to plan our yearly checkups and needed to find a new PCP. After calling about 10 who were either not accepting new patients, or didn’t have any openings for new patients for a few months we finally settled on one. We decided that we would schedule back to back appointments so that way one could be with the kid and then we could switch. These appointments were staggered between 2:45 for the first and 3:15 for the second.

My wife checked in for the appointment at 2:40 and she also checked me in while I walked the kid around in the stroller with the hopes that she would take a nap. After my wife filled out her paperwork, she thought it would be a good idea to hand me mine outside so I could get a head start. This was now around 3:00 p.m. (15 minutes after my wife’s scheduled time.)

At 3:15, which was my scheduled appointment time, my wife had still not been sent back to see the doctor. At this point, I am become a bit irritated, as I continue to walk around outside in 80 degree weather.

3:30 – nothing.

3:45 – nothing.

4:00 – nothing.

4:15 – my wife finally gets sent back to get her vitals taken.

At this time, it’s now an hour and a half past her original appointment time and then she was sent to another room to wait after her vitals were taken.

Finally, at 4:30, 1 hour and 45 minutes after her appointment time, she sees the doctor. This is the same time now that I get my vitals checked, 1 hour and 15 minutes after my scheduled appointment time.

After all was said and done, both of our check ups, in an-office EKG (which came out fine for me), and a few lab scripts later, my wife and I left the parking lot 2 hours and 45 minutes after our initial scheduled appointment time.

To say this was a nightmare and a disaster and an example of some of the negative effects that ACA has caused is an understatement.

There are not many doctors that take MarketPlace plans, this just so happens to be one of them. Which means, all of the people who are on a MarketPlace plan have very few doctors to choose from which creates these enourmous backups.

What’s the longest that you have ever waited for an appointment?

Prior Authorization Needed for Test Strips

One of the many hoops to jump through when you have diabetes is the need for prior authorization.

Last year I had a lot of problems with my Florida Blue health insurance. I documented a lot of this on Twitter and some issues here on the site. I had so many issues with them as a company¬†and then found out that 100% of my doctors and my wife’s healthcare team were going to stop accepting this MarketPlace plan that I had. So, I only had one choice, changes plans.

I switched to a new plan for a January 1 start date and so far everything had been going great. My premiums are cheap, my deductibles are not a bad cost and all three of the major insulins (Novolog, Humalog, and Apidra) are all covered as a Tier 1 drug and covered at a $75/90 day supply.

The prescription process was simple and easy. Everything was great…… until I needed test strips.

Prior Authorization Confusion

My doctor sent in a script for me to test 6 times a day. Problem is, the insurance will only cover 3 times a day. Not a big deal, I will have my doctor send in a prior authorization. Well, here is where it got interesting.

The mail order pharmacy told me that the prior authorization was needed and they provided me with their fax number. I sent that to my doctor and they sent it in right away. A few days later, I called the pharmacy and they said that the insurance company is still not covering the strips. They said that I had to send in for a prior authorization. I explained I did, but, it was sent to the mail order pharmacy and not to the insurance company. I then requested something to be sent to the insurance company. My doctor called me and said that the insurance company doesn’t have a prescription on file. And, they have no clue what the prior authorization is for.

They didn’t have anything on file because the prescription was sent to the mail order pharmacy. After a few back and forths, the insurance company had a 3-way call with my doctor and my mail order pharmacy to get everything straightened out. I still have to wait another day or 2 until it all processes and I can find out if or when I have an order shipping.

Then, to add to that, once it’s ready to ship, I have to provide a different shipping address, so let’s see how that is handled as well.

The short story of the long story is this. Prior authorizations suck. I know at the end of the day (or week or month), I will get what I need because my doctor’s office will ensure that I do, but having to jump through the hoops sucks. And the 4-5 hours total spent on the phone between the insurance, mail order pharmacy and doctor’s office is even worse. The fact that as a type 1, my insurance is only covering 3 tests a day does not make any sense at all.

I can understand 4 times a day, a test before every meal… breakfast, lunch, dinner, bedtime. But only three?

Not cool.

Do you have any tips, horror stories, success stories about prior authorizations? I’d love to hear them. Please share in a comment below or on Facebook.

Update (02/13/17 2:30 PM

I received a phone call from my doctor this morning stating that they received a confirmation letter from the insurance company that the prior authorization has been accepted. I then received a call from the mail order pharmacy shortly after and they stated that they did not see the update on the acceptance of the prior authorization. However, when they attempted to put the claim through, it accepted the larger amount of strips, 6 per day. Unfortunately, the cost came out to over $100 which is not what the price is supposed to be.

One day I will get these strips.

Why I Decided to Start a VLOG

2016 was the year of the podcast. For others, it was the year of the VLOG. For me, it was the realization that blogging just doesn’t do it for me like it once did. Now, I enjoy writing, and I will continue to write. My goal is to create one piece of content every day of 2017. This includes all of my channels and blogs, not just The Life of a Diabetic.

I began to come to this realization when I saw Casey Neistat make the decision to end his VLOG. It just wasn’t challenging him enough and it wasn’t doing for him what it once it did. That is exactly how I feel about my blogging.

Blogging become more of a task than it was a hobby or pleasure. I started to say, “ugh, I need to write something.”

I have not lost my passion to share my voice and advocate and share my experiences in hopes that it will help others. It’s just that I lost the passion to blog consistently.

When I first started blogging, it made me uncomfortable. I was afraid people weren’t going to like the way that I wrote or that they would rip apart my grammar. But then as time went on, I became more and more comfortable writing. To the point that I decided that it was time to start getting paid to write.

Now video on the other hand…… that makes me uncomfortable. Extremely uncomfortable. I am not comfortable with my weight (even before the 10 pounds the camera adds). I just don’t feel comfortable on camera.

Well, that is exactly why I’m going on camera. Because I’m uncomfortable with it and afraid of it.

And the feeling of uncomfort is exactly what I need to feel in order to start something new.

This VLOG is not going to be high quality, great lighting, and Hollywood levels of editing. It is raw (with a few edits). Just like my writing style has always been. There may be bad lighting, bad audio, but it will improve over time.

This VLOG will not just be about diabetes, however, when it is, I will share on the site and my other diabetes related channels.

This VLOG will also include discussions of entrepreneurship, digital marketing, finance, and more. It will not be a daily VLOG of my life.

All videos will be posted to YouTube, so please go subscribe now –

And here is a little teaser video:

Top Posts in 2016

Here are the top 10 most read posts in 2016. Some of these were written in before 2016:

  1. Dario Review
  2. Diabetes in Dunkin Donuts
  3. Fired Up Friday: Diabetic Supplies vs Durable Medical Equipment
  4. JDRF vs ADA
  5. How Low Can You Go?
  6. Contour USB Review
  7. Medco Pharmacy and Tier 3 Drugs
  8. Josh Bleill Motivational Speaker
  9. You Down with PPO or HMO?
  10. OptumRX Strikes Again

Some of these posts may have opinions that may have changed over the time. A lot of these are based on issues that I had that it seems a lot of people have.

Endo Appointment Review – Another Great Discussion

Last Monday was my endo appointment. Unfortunately, I didn’t realize it was my endo appointment, so I didn’t get any blood work done before hand. This would usually be a waste of an appointment, but I’m thankful for the 630G and a lot of great data that we could discuss anyway.

First, we started with an in-office A1C, for whatever that’s worth. 8.1. Not very good. I knew it was going to be high because I spent 45 days without going to the gym and visiting my family in PA, which I tend to eat pretty bad while up there. My weight was down, but only about a pound, not too happy about that.

We couldn’t go over any labs, which I was curious to know where my triglyceride numbers had gone to. Previously, they were amazing, 6 months after being at “heart attack” levels. I’m going to get my blood work done this week, so I am lucky to have an endo that is willing to review my reports after an appointment and send me an email with any recommendations or updates after viewing that.

I had two main concerns going into the appointment, which is how we start out, her asking me, what’s been going on? Morning and after meal spikes. In the morning, as soon as I wake up, my blood sugar just starts to shoot up. Without eating, without drinking anything, just as soon as I wake up, it just shoots up. I do drink coffee pretty soon after I wake up, but I’ve purposely held off on the coffee for a little while and the same thing happened.

What I’ve done in the past is just take a 5-7 unit bolus as soon as I wake up. No real rhyme or reason behind it, just give a little extra insulin to combat that spike that I know is coming. Then, I need to cut out all carbs during breakfast, well as many as I can. I typically eat a 3 egg omelette with cheese or ham in it. When I do this, it definitely helps stabilize my blood sugars until lunch.

But, then that’s when the next issue happens (depending on what’s for lunch). If I eat what I’m supposed to which is a salad with no croutons and a vineagar based dressing, then it doesn’t spike that bad. I can usually control this lunch spike. 

On a good, normal day, I will then hit the gym. This brings down any high that I had and usually drops me pretty low. This is where I see a fun amusement park looking slide on my CGM. This is followed up with a nice, cold Gatorade that also puts back into my body 120 calories that I just burned off.

Dinner is my biggest problem and my biggest spike. Dinner is where I tend to slip up. When I am on my healthy eating habits, none of this happens. So, that is the root cause of the problem. Eating healthier. Unfortunately, I eat unhealthy way too often. When I do, I eat a lot of carbs. Those carbs then cause a spike. I have tried all of the different times to take insulin before eating my meal. I’ve taken insulin 15 minutes before and pre-bolused… same thing. I’ve taken it 30 minutes before, same thing. I’ve taken it the same time I eat, 10 minutes after…. it doesn’t matter.

We discussed that it seems like an insulin sensitivity issue. Where I place my infusion sites is the same areas I’ve been doing it for 11 years. I also use a lot of insulin, so within 2 days there’s nearly 250 units of insulin that has been delivered through that cannula. This is where the problem exists… too much insulin.

We felt that all of these spikes can be resolved with less insulin. So, like I try and do with any problem, we reverse engineered it. I’m using a lot of insulin because of lack of exercise and poor eating habits. So, if we change these two items, I will need less insulin, which will have an effect on my insulin sensitivity. Less insulin being delivered in a short period of time, will allow my body to absorb this insulin and allow the insulin to do what it needs to do.

We also discussed several other things. The use of Metformin as an additional treatment to people with type 1. Invokana being used as an additional med used also.

She knows that I do not like adding additional medications to my list of ones that I’m already using. This is why she will make a recommendation, tell me to do my own homework, talk with people in the DOC and then come back with a decision. So, for now, the goal is to accomplish this all naturally with better eating habits.

There is also the idea of quitting pumping all together and just doing MDI again, but I don’t know if I’m ready for that.

Uncontrolled Diabetes – Honestly I Don’t Care

Last night during the weekly #DCDE Twitter Chat (Tuesdays at 9 p.m.) there was a mention of how HCP’s use the diagnosis code of “Uncontrolled Diabetes” and I tweeted that I don’t really care about that and don’t care what you call it.

I understand that language matters and I totally get it. I, personally, am not really effected that much by the language and wording used in the diabetes world. Myths, yes. But specific words and language, I don’t let it bother me, because at the end of the day, it’s just a word or a phrase. It’s sort of like the old saying from elementary school – “Sticks and Stones may break my bones, but words will never hurt.”

There’s a few reasons why I don’t care about the phrase “Uncontrolled Diabetes”.

First, it’s just a phrase, it’s not that big of a deal. “When I go to get blood work and the receptionist sees ‘uncontrolled diabetes’ they think I’m not working hard to control my diabetes and it undermines all of my hard work.’ Well, guess what? I don’t give a fuck what the receptionist thinks. Nor do I give a fuck about what anybody else thinks when they see “uncontrolled diabetes” I know the work and effort I’m putting in, so I don’t care what others think. I know who I am and that’s all that matters.

Second, what would you rather it say? A Diagnosis code that says “Trying very hard, but still needs some work” or “they really do put in a lot of effort, but they just need a bit more tweaking to keep their BG’s in range for a longer period of time.” I’m just curious as to what the better phrase would be.

Third, and let’s be real here. It’s not controlled. I have no problem being a realist and not trying to fluff myself up. My diabetes isn’t under control. I do what I can to manage it and I can be doing a lot better. More exercise, better eating habits, more weight loss, etc. But when you take a look at some of my CGM graphs and you see roller coaster after roller coaster, guess what, that’s not controlled. So, unless your blood sugars are staying perfectly between the top and bottom line limits that you and your HC team put together, to me, that means it’s not in control.

Here’s an example using a different subject.

If you are driving a car and you are in control of the car, then that means you are staying in your lane and not crossing over the lines into someone else’s lane. If you are driving the car and keep crossing over the lines and are almost hitting other cars because you’re in and out of your own lane, you are an out of control driver…. or an uncontrolled driver. Does that mean you’re a horrible driver? No. Maybe you’re just learning or you’re distracted or maybe it was dark and you didn’t really see the lines that well. All things that you could improve on. But, until you do, you’re still an uncontrolled driver.

I don’t want to undermine anybody’s thoughts and feelings on this topic. If you are outraged by the phrase, then that’s fine, this is just simply my view of it. I am just not a person to be effected by words or phrases that are just used to describe something. I know who I am. I have so much self-awareness of what I am and what I’m not, that it doesn’t matter to me that an outsider sees a diagnosis code and makes a judgement on me.

I Failed My #HAWMC Goal

November was a 30 day challenge to follow the prompts for the Health Advocates Writer’s Monthly Challenge. Well, I failed. I failed to complete the 30 days. In fact, I think I only made it about 15-16 days. I don’t like failing. I don’t like losing.

And what I don’t like even more is having to admit that I lost or that I failed. 

I will not fail again next time that I try this. I learned a lot from it. Writing a post every single day is very difficult to do. Especially with a lot of other things going on, but there are no excuses. When you decide to do something, you have to put all excuses to the side.

I am writing this post today to hold myself accountable. A lot of times, people will only share the good either on their site or Facebook, or wherever. But today, I wanted to share the side of failure.

And because I failed this small goal of one blog post per day, I am going to set an even higher goal to make up for it. And I want to make myself publicly accountable for this new goal. In 2017, I will publish one piece of content a day on one of my few blogs that I write at. Whether it is The Life of a Diabetic, Chris Stocker Inc, CSI Marketing Solutions Blog, or my Medium page, or LinkedIn Publisher page, or even a Snap / Insta story, I will create something every day.

I’ve recently became a huge fan of Tony Robbins. I used to think the guy was a fraud and full of crap, but after watching his documentary (now have seen it 5 times), I am a much bigger believer in what he speaks to. For example, the excuses that I had for not completing my #HAWMC were just stories that I was telling myself over and over and eventually I began to believe those stories. The story that writing a post every day is tough because I don’t have the time. I don’t have the time because I’m running a business, being a parent, being a husband, traveling for holidays and work, etc. The story should be about how easy it is to just write one thing a day, that’s a breeze. There is plenty of time throughout the day to do this.

So, the end of those stories. It’s on to creating more positive stories in my brain.

And today is the beginning of that.