I have always wondered about the blanket statement that, “Diabetics are super expensive,” to insurers. It seems so variable.
For example, I’m a type I with a pump and a Dexcom. I know that I am expensive.
But, I knew a type II who didn’t take very good care of himself. He is deceased now and I don’t see how he was very expensive. He had a couple surgeries to remove part of his leg, but that can’t be very costly compared to me and my supply costs over a long time.
I don’t know exactly what that blanket statement means, but here are my thoughts:
As you say, no statement like that applies to every diabetic. But I think the folks on this forum are from a little to a lot more careful about their condition than the average diabetic. Those that take super care and those that take almost no care at all may be at the extremes of the spectrum. In the vast middle ground, I think there are those that take modest care but perhaps have an incomplete understanding of what it takes to really control their diabetes. And I believe it is this significant group that experiences more emergency room care and hospitalizations which ARE very expensive.
Consider the cost of diabetes complications. If we treat someone for a heart condition or put them on dialysis, we can’t forget that their significant underlying condition was often diabetes. Those costs need to be counted too.
And finally, are we talking about costly on a per person basis, or total cost because there are so many of us? Or both?
Actually there is no tried and true explanation. Fot instance for 20 years I seldom took care of my self and I was very inexpensive to insurance. I bought my insulin out of pocket, no test strips etc.
WhenI did start taking care of my self my cost went sky high. I got a pump, insulin, test strips. If one compared two sides of this case, I was far less expensive than when i was.
Now If one siad what are the long term costs? Say 40 years? Well that might be a different calculation. However had I died in the first 20 years? Heck I would have been a cheap diabetes date for my insurance.
I’ve been spoiled through most of my diabetic history because I have had fabulous insurance because my wife works for a fabulous company. Copays add up, but they are manageable. Never hospitalized for diabetes specifically. Blah blah blah.
I forget I see 5 specialists because of my diabetes—for conditions common in diabetics. Chronic renal failure, plantar fasciitis, carpal tunnel and trigger fingers, potential for retinal problems, etc. Each specialist negotiated a fee with my insurance company so they get a potential repeat “customer”, but they lose $$ they would get if I didn’t have insurance. Same with my pharmacist and DME providers.
There is a lot of money changing hands in the world of diabetes—even glucose tablets and gels are absurdly expensive! (I prefer Skittles and pure maple syrup).
It is harder than ever to find the way through the funny money and find actual costs.
I use 2 vials of insulin a month, 24 vials a year, and now those vials have a retail price close to $150 each. That works out to nearly $4000 a year just for insulin.
I’d be surprised if my insurer is paying even a tenth of that retail price.
Similarly the “full retail” price of a A1C test is more than $60 according to my lab. Yet I’ve seen paperwork that my insurer is only paying a few dollars for bloodwork including A1C and several other tests. Again, funny money, hard to tell.
If you want to protest A1C pricing, you can have it checked at Walgreens. Although, different tests have different results, so you have to alert your Doc.
My very unprofessional opinion here. I have heard that many insurance companies don’t like to pay for all the expensive equipment because they realize why should they. They reason that when the really expensive stuff starts happening, all the complications and all the hospitalization they probably won’t be in the picture and it will another insurance companies problem. So if they don’t cover pumps, CGMs, many daily test strips etc, they reduce their costs and hope it will someone else’s problem.which is why patients and doctors have to fight so darn hard to get things covered. I mean doesn’t everyone want the best possible outcome on life? But it is the all ighty dollar and people with diabetes are expensive. We are expensive if we work hard to try and control our blood sugars. We are expensive if we don’t work as hard and don’t have good blood sugar numbers. We are just darn expensive either way. And also, sad side note, the disease doesn’t play fair. You could do everything right, diet, exercise, medications, blood sugars and still end up with some nasty complications. Just not fair!
My favorite part of the insurance game is preauthoization for needed equipment. My CGM was initially/reluctantly approved for my inability to recognize hypoglycemia. Over time, I acquired a pump. At some point (and post-warranty), the CGM died and had to be reordered. 3 denials (and one month without CGM) later came the MD to MD phone call for my doc to talk to insurance company doc, who said OF COURSE IT’S APPROVED—SHE HAS A PUMP! Oy!
We have had a few insurance discussions regarding the reason for the Dexcom CGM for my T1 who is on a pump. Although we are fortunate enough to be able to have internally recognized hypo symptoms (when awake), while talking with my insurance company, I gloss over that (not lie - just answer quick and move to what I want to discuss) and focus on the INABILITY for nighttime hypo symptoms to be internally recognized and acted upon.
Although this is not a question they ask - I feel it is completely within my prerogative to redirect the conversation to what I feel is important and realistic for our particularly situation.
To date we have not been denied insurance coverage for the CGM but any time the insurance company asks questions, I assume they are asking with the consideration for whether they should or should not continue coverage.
