It’s unfortunate, but our healthcare is primarily controlled by insurance companies. If the insurance companies are acting nice, then it can be our medical team. What about the rights of the patient?
I live with Type 1 Diabetes. This means that I live with a disease that does not go away. It takes zero breaks. It is working on me 24/7/365, so the only way to combat it is to fight back 24/7/365.
Read More
Everyone talks about maintaining health insurance while living with Type 1 Diabetes, but one thing I never put a lot of thought into was life insurance coverage. When I started to explore life insurance options a few years ago, it freaked me out. I started to find out that it was going to be pretty tough to get affordable life insurance as a person with diabetes.
Recently, I came across a company called Health IQ and started to learn some more about them. Back in November 2018, they announced a partnership with Protective Life Insurance Company to create a life insurance option for people with diabetes who are living a healthy lifestyle and managing their diabetes well with a much more cost effective option.
Towards the end of the year last year, I’d say the final 10 days of the year, I went from thinking about going back on a pump to somehow being on the phone with Omnipod ordering my new insulin pump. It all happened pretty quickly, but here’s the story.
I recently wrote about my thoughts of going back on an insulin pump. I was torn between a t:slim and an Omnipod. I’m not going to go into full details of that thought process again, you can read the article.
The final decision for me came down to the fact that I have loved not being connected to a device with a wire for the last year after going back to MDI. I still do not want to be connected to a wire. So, I sat down and outweighed the two most important options, Basal IQ from Tandem or no tubing from Omnipod.
Read More
Have you ever been in a situation where you used up your 90 day supply of insulin well before the 90 days are up? It happens to me quite frequently. In fact, it happens, every single time. I’m usually always down to my last insulin pen or vial when I am re-ordering and it’s a day or two before I am allowed to re-order according to the insurance company.
Why does this happen a lot?
Back in January of 2018, I went off my Medtronic insulin pump that I wore for over 12 years and went back to MDI mixed with Dexcom. During this past year, I’ve had ups and downs with loving and hating MDI. I’ve been asked so many time, “how could you give up a pump to go on MDI?” and the answer has always been simple:
I love the freedom of not being attached to something and my A1C is pretty much the same as it is when I was on a pump.
In a recent article from press release from Blue Cross and Blue Shield of Georgia, they announced virtual clinics for people with type 2 diabetes.
I am sharing this and expanding on this because I think that this is a great opportunity for insurance companies across the country.
The press release states that:
Participants in Onduo’s virtual diabetes clinic will learn more about their body’s response to meals, medication and exercise by tracking their glucose readings in almost real time and seeing patterns that could explain the spikes and dips in their reading numbers. Consumers also will have ongoing access to a care team — including coaches, diabetes educators and doctors — for support in managing their diabetes.
People can participate in this virtual diabetes clinic if they are enrolled in certain BCBSGa plans. In the long run, offering these types of virtual clinics for people living with type 2 diabetes can help lower costs for the insurance companies.
People who are more educated and knowledgable about a disease can make better decisions towards a healthier lifestyle.
I’d like to say bravo to BCBSGa for doing this.
Do you know of other insurance companies around the country that are doing this?
I’d love to hear more about other insurance companies that are also doing this.
Taking this one step further, I think these virtual clinics should be offered to anyone who is enrolled in the insurance program.
Why?
Maybe someone doesn’t know that they have diabetes, like the millions and millions of Americans who currently don’t even know they have diabetes. This virtual clinic could help them understand signs and symptoms and figure out that they may just have diabetes.
Going even further, open the clinic up to educate people on heart disease and other common diseases in America.
These virtual clinics can be opened up by people outside of the insurance industry too.
Do you think that a pharmaceutical company wouldn’t want to fund these type of clinics? Knowing that if any of these people actually do have Type 2 that they aren’t going to end up on one of their drugs?
To add to this, people who participate in these type of clinics, will more than likely have a much better quality of life and better health than those that don’t. Having type 2 diabetes and being “healthy” can be extremely important for things like no exam life insurance for diabetics.
Virtual clinics are so important because people can’t always just get up and go to an in-person clinic or educational meet up. Maybe they don’t have a ride, are sick, immobile, whatever the case is, but they can’t make it to the clinic to receive the education they need, so now they have to lose out?
Absolutely not!
That’s why virtual clinics like these need to be around.
Like what you read? Then sign up for The Life of a Diabetic newsletter to get all the week’s posts delivered directly to your email every Saturday morning.
A recent study from the Kaiser Family Foundation reported in Becker’s Hospital Review breaks down how many patients in each state skip a physician visit due to cost.
I always like to look at these lists to see the top states and bottom states on these lists and think about maybe why these particular states are where they are.
In this particular case, my mind went a different way with this. My mind went to the idea of what happens when these patients skip visits.
Something that Victor Montori writes about in his book, Why We Revolt is that some times patients can’t afford a visit or just can’t make a visit for a specific reason and then that patient is deemed to be non-compliant.
The word non-compliant is a whole other issue and people like Renza can go into more detail on why language matters, but for this post, I will use that phrase.
Let’s say that I might be the most compliant, best patient out there and eager to do what I need to do in order to have a better doctor visit than the last one. So, that means I ate better, I exercised, I got better sleep and I took all the meds I was supposed to take.
But, unfortunately, I had a client become late on a payment and I had to fork out some money for some other non-health related emergency and next thing you know, I can’t afford my co-pay or other out of pocket expenses to go see my doctor.
Now, I look like a bad patient. My health potentially gets worse because I’m not able to review the lab results until I can afford to go see my doctor. But now, I have even more medications and tests that need to be done the next time, causing me to have even less and less money to afford future appointments.
Next thing you know, I’m being admitted to the hospital for poor health all because I couldn’t afford to go see a doctor.
Now, this exact situation hasn’t happened to me, per say, but it happens every single day.
What are the reasons behind why people in Texas, Mississippi, Louisiana, Georgie and Nevada to round out the top 5 can’t afford to visit their doctor?
Is it due to just overall struggling economies in those states?
Is it because of poor insurance coverage from Marketplace plans in those states?
Why do people in Iowa, North Dakota, Hawaii, Vermont and Massachusetts all have a far less harder time affording to go see their doctors?
These are questions that I always wonder when I see these lists.
I, for one, am glad to see that PA is 9th from the bottom of the list.
Share this article on Facebook or Twitter now and keep the conversation going.
Like what you read? Then sign up for The Life of a Diabetic newsletter to get all the week’s posts delivered directly to your email every Saturday morning.
Since I moved to a different state a couple of months back, I was able to change my Marketplace insurance in the middle of the year. Unfortunately, I now have to switch back to CVS from Walgreens, which is where all of my prescriptions are at.
I unfortunately cannot get in to see my new endo until the middle of August and my old one is not going to send any more prescriptions because the last one was the last because I moved. But, there are still two 90 day refills left with Walgreens, but I need to try and get them transferred over to CVS. I really, really hope that I can do this.
Has anyone had any experience in this?
This is one thing that I thought I timed up perfectly, but I guess I didn’t. I knew that my old insurance was going to expire on at the end of May and that my new insurance would kick in starting June 1, however, what I didn’t expect to happen was to have such a long waiting period to see the new endo.
I should have known that was going to be the case though because there is always a long waiting period to be seen as a new patient.
Luckily, I don’t have any issues with insulin, for now. I should be good on that until I see the new endo, but I am going to still try and get the prescriptions switched over.
I’ll keep you updated.
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?
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.
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.