Dinosaurs and Good Health Care Insurance

From my blog The Perfect D:

What do dinosaurs and good health care insurance have in common?

Both are extinct.

At least in my world. I am longing for the days of my youth, when my parents’ health coverage was super-duper. It was like living on Big Rock Candy Mountain, except it was insulin that flowed freely and test strips that grew on trees. I had numerous in-patient visits to Joslin Clinic and not once did we worry about insurance issues. (Except when a study was supposed to cover labs that were in addition to my normal labs and kept billing insurance for them. That’s a funny story for another time. Promise I’ll get back to that.)

Good-bye Candy Mountain. When I began work after university, I learned about “pre-existing conditions” exclusionary policies and dealt with purchasing insulin and supplies out of my own pocket (and sometimes getting an extra vial from my doctor). Please forgive me for waxing nostalgic, but I remember when I could buy a vial for $30. I wasn’t testing quite as frequently, but I was getting by, waiting for the one year “no diabetes coverage because it was pre-existing” to be up.

I got up close and personal with the ugly side of exclusionary policies when, at 23, I developed pancreatitis and was hospitalized for six days. The ER doctor had written in the intake notes that my blood sugar was elevated and I had ketones in my urine upon arrival, and the insurance company denied coverage due to “DKA”. It took me making phone calls from the hospital bed and getting records changed to show that I was admitted to the ER and hospital for pancreatitis and nothing to do with my diabetes. I would have ended up with an almost $40,000 bill otherwise.

Over the years, I’ve had some good health care insurance plans and some not so good, but now… I’m staring into the abyss of the high care deductible insurance plans that are all the rage these days. I’ve talked about how expensive it is to take care of diabetes, but as John will be changing jobs soon, I’m grimly steeling my jaw at the upcoming changes.

High-deductible health care plans are great if you are healthy. They suck if you have a chronic illness. They’re actually classified as “catastrophic illness” plans and feel like such. More and more companies in the U.S. are choosing to go to these plans, because… they’re cheap. If you’re going to offer a health care option for your employees (soon to be mandatory in 2014 for U.S. companies), this is what everyone says is the cheapest way to do it. You pay a premium, you pay everything until you meet a ridiculous deductible, and then coverage kicks in.

We did it last year. Choices were made that I never thought I would have to do when it came to my health. Priorities were made. Prescriptions have to be paid up front and I need insulin and strips, so no delaying those purchases. Alas, my CGM sensors were shoved at the bottom and not purchased until the crazy stupid deductible was met with a string of surgeries that couldn’t be put off. The same is happening now. I’m not paying $60 for two vials of insulin. I’m paying $296. Don’t get me started on the rest of my supplies.

(I understand why some supplies are expensive. They have to cover the cost of research. But I have an issue when I am told that with an insurance discount (and I know that my insurance does not pay for any of it, thank you very much, so there is no discount…), a particular supply is around $300, but without insurance, it’s $795 according to the packing slip. Who is going to pay that? Not me. Probably not you.)

John’s new job has a “traditional” health plan option that doesn’t require a deductible for prescriptions. I’m sure that there are caps and limits and denials coming ahead. I also wonder when they’ll drop that and only offer high deductible plans. We don’t have an extra $1096 a month to shell out for 7 months before insurance steps up to the plate to pay part of my prescriptions and medical supplies. I’m so angry I could roar like a T-Rex.

Poor dinosaurs. I am starting to understand how they felt.

How do other diabetics deal with high deductible insurance plans? I’d love to hear from other Type 1s who have these…

This seems to be a very big deal. I never paid attention to this stuff, just buy it and pay the bills, but started recently and it appears that I'm getting a used car every few months, except it's little plastic things I jab into my abdomen and throw out. I also went through my yearly round with BCBS, they don't like One Touch and would prefer I use some other meter although they won't provide me any information as to the accuracy of any other meters, although they include Bayer, which I'd seen some blurbs about them having an enormous recall? Great!! That'd be awesome to ditch the company I've used since 1984 and go with some other product I'd just guess as to which one I'd prefer to use because both insurer and doctors, who undoubtedly have some idea which ones suck and which ones done, won't say because they are pwned by pharmaceutical companies! Maybe not. I protested and they've approved the One Touch for another year but I will go through the same shenanigans next year I'm sure. I don't get what they get out of it. I made sure to torture several of their customer service people with 45 minute phone calls asking questions engineered to make them uncomfortable about the process. At one point, they suggested that if the doctor called and requested that they make the request "urgent", they would make it urgent which prompted a 20 minute declamation about "why can't I make it urgent?". I find the whole process absurd, except that it gets completely in the way of our health.

I haven't had to deal with this -- yet -- but Medicare is getting very close so I expect I will have some nice horror stories to tell in a couple of years.

acidrock -- on the topic of meter accuracy . . . Bernstein tests them from time to time; currently he recommends the Accu-Chek Aviva as the most consistent and accurate one out there. I switched to it a year or two back and have been very pleased -- my readings are always within 4% of the lab. Sometimes they are right on.

That said, peoples' experience with meters varies as much as anything else diabetic. For any given meter, you will find people who swear by it, and others who swear at it. Ultimately you have to determine empirically what works for you. As always.