Fired Up Friday – Diabetic Supplies vs Durable Medical Equipment

I am sure you all know exactly what I am talking about just from reading the headline of the post.  If you don’t, then I will explain.  The insurance company looks at your different type of supplies in two main categories, prescription and durable medical equipment.  The way your insurance company defines them is most likely very similar, some minor differences I’m sure, but overall the same.  Now, what is the biggest difference to you?  Prescription is usually just a co-pay, for instance, $90 for a 90 day mail order supply.  Durable medical equipment (DME) products must be paid for with your deductible at first and then there is a yearly maximum that the insurance company will cover.

I’ll use my personal insurance numbers as examples for today because I don’t mind disclosing values.  I pay$115 a month for insurance through Cobra since I was fired back in November.  With that, I get my insulin which is a prescription, at $90 for a 90 day supply, which is about 16 vials of insulin.  My testing strips I get at the same rate, $90 for a 90 day supply.  I test about 10 times a day, so that’s 300 strips a month, so 6 boxes a month, which is an order of 18 boxes of strips for $90, can’t beat that. Now, the costly stuff comes in with the insulin pump supplies.  I have a $1,500 deductible, so I will have to pay $1,500 out of pocket before the insurance even begins to cover it.  This is about one 3 motnh supply worth of infusion sets and reservoirs, more on that later.  After that $1,500 is met, then insurance company covers only a maximum of $2,000 for the year, so they will cover only one more 90 day supply.  So that leaves me with 6 months to have to pay for infusion sets and reservoirs myself.

Here is where my problem with the insurance companies comes up.  Why do they consider my infusion sets durable medical equipment and not as a diabetic supply?  Diabetic supplies are covered by your prescription plan which would just be a $90 co-payment.  I understand that people use infusion sets for other things other than diabetes, but if I am using them to manage my diabetes, wouldn’t that be considered a diabetic supply?  This is just another way that the insurance companies can force you into paying extra money in order to survive.

Is there anything that we can do about this?  I really don’t think there is, but I wish that we could.  It is just irritating to know that this is a supply that I need to control my diabetes, so doesn’t that make it a diabetic supply?  Now, I don’t know if you all know how exactly products are billed to the insurance companies, but I will give a little advice on to how this is done.  Your supply company basically charges 3 times the amount of what you would pay to purchase it with cash online.  For instance, if you could buy directly from supplier at $100, they will bill the insurance company $300.  So that eats up your yearly maximum 3 times as fast.

First thing that I would suggest to you, is to find out the policy with your insurance company for reimbursement for submitting invoices.  Some insurance companies will allow you to purchase your insulin pump supplies in cash and then submit the invoice to them for payment.  This could save you a lot of money in the long term because you can get 3 times more in supplies.

Well, like always, I want to hear your feedback.  Leave a comment, hit me up on Twitter, e-mail me, do whatever you want, but I want to hear your opinions.

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How Diabetes Created My Business

Growing up I always had dreams of owning my own business in New York City in a big high rise building. When I was hit with the diagnosis of diabetes when I was 19 those dreams still were there. After a few years of having diabetes and realizing what the insurance side of diabetes was like I started to become discouraged about owning my own business. How would I get insurance if I owned my own company. These are still my biggest concerns.

Diabetes introduced me to blogging which led me to social media. I started blogging everyday, going on social media sites, started working on design, started learning about search engines and how they work and different marketing techniques. I started to think to myself damn this is awesome, I would love to do this for a living. But, how will I pay for insurance.

So while still working for that old company I began to do some consulting, giving advice to people on how to rank better in Google and then teaching them about Twitter and showing then how Facebook = easy money. So then popped up CSI Marketing Solutions, LLC.

Right now I have insurance through Cobra for the next 18 months so the insurance part of owning my own business is not as much of a concern. So this is how diabetes has led to me owning my own business. If it wasn’t for diabetes who knows if I would have created a web design an search marketing consulting company.

It’s times like this that make me thankful to be diabetic.

Have a great weekend everybody.

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Changing Jobs – Diabetes Style

Like I mentioned briefly yesterday, I am in the process of changing jobs.  I am no longer working at the diabetes supply company that I used to, so I guess I can take that out of my disclosure of the website now.  I won’t get into details of why I am no longer there, but the most important part is that both sides are happy and it’s time to move on.  I am still running CSI Marketing Solutions LLC, but due to the fact that I have this thing called diabetes I can’t work solely on this, I have to work for a corporation as well in order to have health insurance.  I am currently seeking a new job, and I would love to get a new job doing what I love to do, social media and internet marketing.  If not, then I will find something that I don’t mind doing.

While changing job for most people can be difficult, but when you have diabetes there is a whole other game added to it.  Sure, everybody has bills that they have to pay and families they have to take care of, but when you have diabetes, you have one of the most expensive diseases to manage it and there really isn’t much help out there for you if you don’t have insurance.  There are resources, but they are limited and they can still be way too much for those without a job.

Then when you finally do get a new job, some places don’t give you health insurance right away, let’s say for example a 90 day period before health insurance kicks in.  Well since we have this pre-existing condition BS, we have to prove to the insurance company that we have had credible insurance coverage within 63 days, and if you haven’t then you will not receive insurance for 12 months due to that pre-existing.  So if you have 63 days to prove your coverage, but your insurance doesn’t kick in for 90 days, what are you supposed to do?  If you’re married, which I’m not, you can try to get insurance through your spouse.  Amanda is not working full-time because she is finishing up her degree, also we’re not married so that’s not an option.

The next option is to pick up Cobra.  I don’t know too much about it, but when I had discussed with them two years ago when I thought I was going to have to pick it up, it was going to cost me nearly $650 a month.  How the heck are you supposed to pay for that.  I’m not even sure what it covers, but I’m guessing you still have to pay for strips, insulin, pump supplies, doctors visits, and even blood work?  If you have answers, please let me know.

Gee, I would sure like to have a new health care system that didn’t force you to work for  a corporation in order to get health insurance.  How about you let 50 uninsured diabetics get together on the same insurance plan, just like a small business with 50 employees, and even let their family members on board as well, so let’s say it ends up being 100-150 people on the plan and they pay a premium just like anybody else would for a small business.  Why can’t we do that?  It would be the same thing as a small business.  Oh, I know, because when 50 employees at a small business get a group plan, there is only a few diabetics, so the insurance company still makes their money from the “healthy” people that are just paying a monthly premium.

I better stop now, I’ll get back to this another time.

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A New Baby, A New Life

Well the Phillies are still alive and the Eagles kicked butt on Sunday.  I have missed 3 Panthers hockey games now because I have had to stay home to watch the Phillies.  As long as they win, I don’t really care.  I received some good feedback on my post about diabetes being a disability and also want to thank those that commented on my birthday, I appreciate it.  Yesterday I was a little sick and didn’t go to work because I wasn’t sure if I was coming down with something worse and I didn’t want to spread it to any of my co-workers.  When I woke up this morning I felt a little better so I went into work.

I have a lot of research that needs to be done about Cobra.  For those of you that are currently using Cobra, please e-mail me at chris.stocker – at – thelifeofadiabetic dot com.  I’m not going to go into in the blog post today, so if you are interested or have any comments on Cobra, please e-mail me.

Now onto the good news today.  I am officially an uncle as of 3:30 a.m. this morning.  My sister-in-law had been in labor for about a day, but just went to the hospital yesterday after going to see the doctor.  My brother sent me a text early in the morning.  Unfortunately, I am not able to make it up to see her right now.  Her name is Sylvia.  I will post some pictures as soon as I get them (My iPhone can’t get MMS messages).  Hopefully, I can get up there to see her for Thanksgiving, if not then I will definitely see her during Christmas time.  The baby not only brings a new life into this world, but a new life and journey for those involved.  I have a lot of work to get to now, so I will post more about the newborn baby when I can.

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MMM….Insulin

MMM….Insulin.  That’s what I said to myself today around 10:00 a.m. when a co-worker came up to my desk and said, there’s a package downstairs for you.  I was starting to get extremely nervous because about 20 minutes before that, my pump beeped and said “Low Reservoir” and I was completely out of insulin.  I am supposed to get a phone call when my insulin is shipped, but I never received a phone call, so I was really worried because it was Friday and I knew it wouldn’t be delivered on the weekend.  I finally received that call about 3 hours after the insulin was delivered, what good was that?

Once that new shipment of insulin came I took out 1 vial to let it settle to room temperature because I knew I would need to re-fill it soon.  I think we all know that cold insulin does not feel good at all.  I can remember the first time I took cold insulin, it was through an insulin pen, it burned like crazy.  I felt like somebody took a lighter and just put it up to my skin.  Never did that ever again. Now, into the problem that I have with my insulin company.

I have never seen a company so…ridiculous…for a lack of words.  It is the mail order company that my insurance requires me to use for my mail order services.  Last Friday I filled out the order form and faxed it in and faxed in the prescription that my doctor had just written out for me.  Not good enough for them because the prescription has to come directly from the doctor.  So, I called the doctor’s office and they then faxed it over to them.  Nope, still not good enough.  I have to fill out the order form myself, with my insurance information, billing, shipping, all the good stuff.  Then I have to fax that form to my doctor, who then has to fill out the prescription on that piece of paper, so it can’t be a separate prescription, it has to be hand-written onto that sheet.  Then finally my doctor’s office can fax it over.  So this took up until Monday to finally complete.  Then once they receive it, it takes 24-48 hours to enter the order into the system (I don’t know how it can take that long).  Once the order is in the system it takes 3-5 business to process the order (once again, no idea how it takes that long), but oh don’t worry they ship it overnight for free.  Well you freakin should for taking a damn week to process it!

Well, as you see here, my insulin is in my possession, finally, and I am very happy to see it here.  Time to now put it into the fridge and let it stay there until I need it.  Luckily I won’t have to go through this in December when I re-order because the prescription will be on file.

Well, it’s 8:00 p.m. Friday night, I need to go.  Good news today, my LLC finally went through, official company name is “CSI Marketing Solutions, LLC”

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Insurance Companies, Did You Just Cringe?

Insurance companies.  How many of you just cringed and made a sour face as soon as you read those first two words?  I know I do.  I don’t know what it is about that set of words. Even when I was younger I didn’t like those words, and I didn’t even know anything about them.  As my uncle always called them, “in-case-stuff-happens companies” as in they are useless unless stuff happens.  Insurance companies brought a whole new level of hatred into my life when I became diabetic.

I didn’t really deal with them the first 2 years of my diabetes because my mom handled just about everything.  I just simply went to the pharmacy to pick up my prescriptions and went to the doctors office and handed them a card.  Once I moved to Florida to finish college, that’s when I had to deal with things myself.

I can remember the first bad experience that I had with them.  I had only 1 vial of insulin left and I pulled it out of the fridge to get it to room temperature about a day or 2 before I would actually use it.  As I was taking it out of the nice little box it comes in, it slipped out of my hands and smashed on the floor and insulin went everywhere.  Not only did I have an insulin smelling floor, (disgusting!) I was now going to be out of insulin within the next few days.

I went over to the student pharmacy the next day and pharmacist said ok it should be here tomorrow.  I get a phone call the next morning to come in and see him.  Guess what?  Insulin is there but the insurance company isn’t covering it so it is going to cost me approximately $500 with the student discount.  Reason for why they won’t cover it you may ask?  Because I have a 90 day supply and we are only on day number 78.  I still remember the day of my 90 day prescription I was on because it made me so pissed.  After I explained to the rep that I will be dead before day 90 comes around, she transferred me to multiple people.  Finally, on a one time basis, they will cover the insulin.

Now, fast forward 3 1/2 years to last week.  I received a new pump and CGM from my diabetes supplier earlier in the year. They are out of network with my insurance so no big deal, that will eat up my out of network deductible.  Well I keep receiving statements in the mail showing that none of my deductible has been met.  This doesn’t make sense to me.  Also, every month I receive a letter telling me that I haven’t sent in the additional information that was requested of me and I must send in something in writing or my claim will be denied.

Huh?  What?  I never received anything in the mail stating I had to send in anything!  Every single time I call they tell me that I just have to submit my appeal in writing.  Well, what the hell am I appealing?  I haven’t received anything telling me I need to appeal!  Long story short they are requesting months of blood sugar logs, CGM reports, A1C reports, etc.  If they just would have told me that months ago I could have had it to them right away.  Hopefully I can get this all straightened out and taken care of.  I don’t need the added stress.

Just another reason I can’t stand insurance companies!

And just another day in the life of a diabetic

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