Category: Insurance

I have not had an appointment with my endo in a really long time.  The last 3 appointments that I was supposed to have were either cancelled by myself or by the doctor because of scheduling conflicts.  I think that the last one that I had was in December.  That also means, that is the last time that I got my blood work done.  I had a script to get the blood work done for each of the appointments, but I never did it.  Now I have to have the office mail me another script because they are only good for 30 days.  Sometimes this gets annoying, but it’s all part of living with diabetes I guess.  And since I have a diabetes blog, I’m allowed to bitch about it!

My appointment is scheduled for later this month, don’t ask me when, because honestly I don’t know.  All I know is that I have to get blood work done this weekend.  I have not been the best diabetic in the past few months, but I’ve been getting better.  I’ve been eating a lot better and I have also been exercising a little more.  Walking our new dog really helps add some exercise into my life.  My biggest concern for this appointment is that I need a new prescription for my testings trips because I am almost out, and I need to switch to a different brand.  Why am I switching?  Because I refuse to pay $150 for a 90 day supply for Freestyle Lite when I can get a 90 day supply of One Touch Ultra strips for only $25 for a 90 day supply.  Freestyle Lite strips are my favorite.  I have used just about every brand that is out there… that was one of the few perks of working at a supply company for three years…. which by the look of it, they will be going out of business soon, but that’s a whole other side story.

So basically, my insurance company is forcing me to switch to another brand.  I used to use the One Touch strips before the Freestyle Lite came out, but then I was hooked.  I just like it so much better.  There was also the whole counterfeit strip fiasco that happened several years ago, and recently again.  (I can’t go too far into this, that shitty company I used to work for may try to sue me). My endo always asked me why I didn’t use the One Touch meter because it links so easily with the Medtronic insulin pump that I use.  *Sidenote* I am notorious for just guessing my blood sugar or just punching in a bolus number for my pump, and not allowing the pump to do the calculations for me*  So my  doctor felt that this would solve that issue.

I do plan on using the lancing device from the Freestyle Lite meter though.  I don’t have to worry about lancets because the insurance company sent me 1,000 lancets in my last order, and I change it overtime I open a new bottle of strips, so that is like 1-2 weeks, so I should be set for a good amount of time.  That was a mixup on their part anyway…they sent me 600 strips and 1,000 lancets.  Does that make any sense?

Well, I think I covered just about everything that I wanted to.  I’m going to finish my wonderful ceasar salad i’m eating right now and then get back to work.  Down 4 pounds in month of May, have to keep it up.

 

On January 1, 2011, my insurance, United Healthcare, who uses Medco as their mail order pharmacy, made the decision that the type of insulin that I use, Novolog is a tier 3 drug.  What does that mean?  That means that instead of last year when I paid $25 for a 3 month supply, I now pay $150 for a 3 month supply.  I noticed that Humalog, which I used to use before I went on an insulin pump, is still a tier 1 drug and still costs only $25 for a 90 day supply.  When I asked why Novolog was bumped up to a tier 3, they said they didn’t know, which I didn’t expect that exact person to know, but somebody had to know and there had to be some sort of documentation out there on why this was bumped to a tier 3.

I still have not been able to find any information, so I am just curious as to why one is considered one thing and the other is not.  I don’t think there is some sort of huge conspiracy here, I just want to know.  Is there a possibility that it could be that more people use Novolog, so that way they charge more for it?  Or they don’t have a good relationship with that manufacturer and they don’t get as good of a deal on it?

Does anybody have any information on this?

Ok, I posted earlier in the week that I was getting a little nervous because I had to re-order my insulin shortly, but it was with a new insurance company and something always seems to go wrong.  It is only a one month RX, so I didn’t call it into the insurance company and use their mail order because it wouldn’t make sense to do that.  The nearest pharmacy to my work is Target and I wanted to drop it off today and pick it up tomorrow.  So I went through the process today to get the RX filled.

I called my doctor and had them fax a prescription to Target.  I waited a few hours and called Target and they said that the RX didn’t make sense so they called and left a message for my doctor’s office to fax over another RX.  Well that didn’t make sense because the doctor’s phone is always answered, no matter what.  I then called my doctor’s office and they said, “nope, never received a call.”  So now Target is pissing me off by this point by just pushing it to the side.

My doctor’s office re-faxed it over and everything was good.  They told me I could pick it up at 3:00 today, but I couldn’t get out of work in time before they closed so I am just going to pick it up tomorrow and have it before the weekend starts.

I knew that there would be some sort of issue, but this time it wasn’t even involving the insurance company, but with the pharmacy.  Well that was my wonderful day and my insulin story.  To be continued tomorrow I guess to see if it goes smoothly, hopefully it does.  I do not have much insulin left.  I am down to one full vial of insulin which gives me about 5-7 days, depending on how much I eat during that time.

Have a great Friday tomorrow everybody!

A lot of words don’t really scare me, but these two words when used in the same sentence definitely scare the hell out of me, insulin and insurance.  My life depends on both of them.  Basically, I can’t live without either one.  Without insulin, my blood sugar shoots up sky high and good things are not bound to happen.  Without insurance, I am not going to be able to continue to afford the amount of insulin that I use.  (Yes, I know technically I can get insulin without insurance, but I use a lot of insulin, so there is no way that I could afford it).

It is coming up on my time to re-order my insulin.  The last time that I re-ordered was back in September, and I was using my Aetna insurance that I had for almost a year, so I was comfortable with their mail order and knew exactly how long it would take before the insulin was actually in my hands.  This time, I am going to have to use Medco for the first time.  I have heard good things, and I have heard bad things about them, just like any insurance company.

My biggest concern is just the first order.  There is always something that seems to go wrong with the first order.  Whether it is that that RX was not faxed in time, it was faxed to the wrong number or department, it wasn’t filled out properly, it was received after hours, or it takes 7-10 business days to process the RX (which is just ridiculous because there is no way nor reason why it should take that long).  And yes, these are all responses from insurance companies that I have received over the years.

I will be attempting to re-order my insulin some time this week.  I have to get only a one month prescription from the doctor because I have another appointment on December 3, so she wants to see me to see what kind of changes need to be made before giving 3 month prescriptions for strips, infusion sets, strips, and the whole works.  I’m still striving to cut weight to get myself that OmniPod I want!

Well have a great week everybody.

Phew!!  That was a close one.  My Cobra insurance was almost cancelled!  How much of a hellish experience would that have been if it did happen.  Here is the story.  I normally pay my Cobra insurance a month in advance.  So in April, I send a check for May, etc.  For some odd reason, I didn’t send a check in March to pay for April, so when I sent a check in April, it was paying for that month, not paying for May.  The other day I received my invoice and it said that I owed for May and I had to pay before May 31 or my coverage is cancelled, and they are not flexible with their payment dates AT ALL!.  So it was May 31 and the post offices are closed so I am freaking out.  Finally, I was able to speak to them on Tuesday, June 1 and they said that since May 31 was a holiday, they will accept the payment as long as it is postmarked on or before June 1.

Well, I never drove faster to the post office in my life!  I did not take any chances and had it overnighted.  I took the extra charges to overnight it because I wasn’t 100% sure if it went regular mail that it would be post-marked by that day.  If it was sent overnight, I knew it would be post-marked.

I plan on calling later today to find out if they received the check and if everything is good to go with it.

What a close one.

After having Cobra for 3 months, and not even knowing it, I have finally figured it all out.  I was so confused about the whole situation and couldn’t get a clear answer for a while.  I called Ceridian Benefits, who runs the Cobra program to get some answers.  Here are the questions that I wanted answers to:

• When does my coverage start?
• Am I up to date on my payments?
• Am I covered now?
• Why does my invoice show a payment for December when it’s not February?
• What card do I use, what is my member ID?
• How do I get my diabetes supplies?

Well, let’s go into each of these questions, and if you ever had questions about Cobra, I hope this post helps you out.

When does my coverage start?

Well this one was a pretty simple answer, it never ended.  I did not know that from the day that I was fired, and the insurance rep called me and I told him that I was going to opt in for Cobra that he continued my service as is.  He did this to make sure that there was no break in coverage and that I had the continuing of coverage within the 63 days.

Am I up to date on my payments?

I sent in a check to pay for December, January, and February, but I haven’t seen the check cleared yet so I was a little worried that it wasn’t paid.  When I spoke to the customer service rep, she assured me that the system showed paid and she gave me a confirmation number of the payment, so I guess it’s time to figure that out with the bank.

Am I covered now?

This is was somewhat of a repetitive question, but I had to double check.  Yes my coverage has been active since December, which I would have known that when I went to the clinic for the clogged Eustachian Tube.

What card do I use, what is my member ID?

This is the one that I was the most confused with because I wasn’t sure how it worked.  I was waiting for a card to get sent to me that is why I didn’t think that my coverage had started yet.  The reason that I didn’t get a card sent to me is because you are supposed to use the same exact card and member ID number that you had with the insurance company.  So, since I had insurance through Aetna, I will continue to use that card for coverage.

How do I get my diabetes supplies?

This is just like the last question.  I still get my supplies from the same way that I would get them previously through Aetna. This is great for my insulin, and for testing strips because each of those is just a $90 co-pay for 90 day supply.  The insulin pump supplies are where it gets tricky and pretty much sucks.  Since pump supplies are considered durable medical equipment, I have to meet a $1,000 deductible first.  After that $1,000 is up then Aetna will cover it, but only up to a $2,000 maximum!  $2,000 maximum for pump supplies, are you serious?  That’s like a one month supply with the way that the supply companies charge the insurance companies (trust me I know from being on the inside of the supply company).

Well this customer service rep that I spoke to was a lot of help.  Other insurance companies should take notes on customer service because these people are great. I spoke to about 3 different people in my calls to them and they have each been excellent.  I hope this had helped any of you that have had questions about Cobra and continuing insurance coverage previously.