Frustrated

Type 1 and LADA
1

Hello all! I'm very frustrated with my current PCP and insurance provider. Have any of you had an experience like this? What did you do? (Sorry if this post is long and boring!)

I recently switch insurance providers due to a new job. I have been very disappointed with my experiences so far.

I am a T1 and my husband and I are trying to have a baby. Anyone in this same boat knows that top diabetes care and management is key to having a healthy pregnancy and baby, and that blood sugars are very wacky, for lack of a better term, during that time. This is my top concern and my priority right now.

With my previous insurance provider, I had regular appointments with a pre-pregnancy diabetes counselor/educator. Her main job was to get my blood sugar to where it needed to be to be as healthy as possible when I got pregnant. I was in contact with her weekly and I loved it. I also had a team of doctors there that would be my doctors throughout my pregnancy and during delivery, so they would all know me and my diabetes throughout the entire process.

With my new insurance, I had to select a PCP and make an appointment in order to get a referral to an endocrinologist. The first 2 appointments I made had to be canceled because the doctor was out of the office, and the second appointment got canceled because she was moving. I selected a new PCP and finally had my appointment.

During this appointment, I asked numerous questions about the care I would receive for pre-pregnancy and pregnancy. She said that with this insurance, there's no pre-pregnancy counseling, and that I would just go to a normal endo throughout my pregnancy. When it came time to deliver, I would have to go to a completely different hospital that has no affiliation with the endo I'll be seeing and will have completely new doctors for just the labor and delivery. I expressed concern about that and she said, "To tell you the truth, diabetes is very easy to manage when you're pregnant, so don't worry about that." That is the complete opposite of everything I've been told.

She answered some other questions (incorrectly), told me that she used to be in OB, so she knows about diabetes management, and gave me my referral. I made my two appointments with the diabetes educator and endocrinologist (luckily, I've seen them years ago) and I thought I would just ask them their procedures once I got there. Well, a day later I got a voice mail from my PCP that said she gave me the wrong referral and that "all bad cases of diabetes" go to a lady at a different clinic and that I need to call and make an appointment with her instead. "She deals with all the really bad cases of diabetes, so she will know what to do."

I also got a letter in the mail saying that since this is a specialty visit, no labs can be performed unless it's an emergency. All labs have to be done at your primary care clinic in order to be covered under the insurance. Are you kidding? I get labs done every time I go to the endo. So now you're telling me that I have to take more time off of work just to go get labs done that have to go back to my endo anyway?

I'm sorry for the long post, I'm just very frustrated and scared that I don't have the care that I need.

2

PS.. I'm not sure why there are hyperlinks in this post.. I did not put them there.

3

My son is 37. It was a different time in diabetes, but it worked out just fine (except his blood glucose was low at birth, as mine was high and his pancreas tried to fix that.)

Here is my major thought: are you seeing an OB/GYN? I would start there. The delivery doctor can point you to the correct specialists who have privileges at the same hospital, folks he/she has worked with in the past.

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This is somewhat off-topic, but I would have slapped that doc if she said something about my being a "bad case" Jeez. Anyway, good luck and keep us posted. Just stay strong and politely demand what you need.

5

Ask to be assigned an endo for your primary care doc or a diabetologist if there is one.
There is just 1 in my insurance plan and I don’t much like him. But he knows so much about all the different nuances that I would not think to switch.
My previous doc pretty much knew nothing except " try to have tighter control" and " count carbs" but now my diabetologist tracks everything and tells me what I need and his staff nags me to get my labs and eyes tested etc etc.
I never thought it would matter but a doc who lives it and is on the edge of all the new things coming out and new treatments

When you know more than your doc does about your condition, it is time for a change.

6

There are no hyperlinks in your post, you may want to check your computer for adware (Ask Toolbar, etc)

It seems that your new insurance is a lot worse than your old one. One of the hazards of changing jobs. One of the things keeping in my job.

The referral thing is quite common. A lot of insurances require this.

Good thing you switch PCPs it sounds like the first one doesn't really care about patients.

The labs can be done at the PCP clinic, as long as you get a lab slip from the Endo at the previous visit. I usually get the labs done 1 week before the Endo appointment, that way the labs are complete when you visit the Endo. Same with the specialty gal, she can give you a lab slip, you take it to the PCP clinic, and get them done. Have the results sent to your PCP and Endo at the same time so you may be able to eliminate some duplicate labs.

I handle the clinic labs by going early (labs start at 7am) on my way to work, so I can be fasting, or just not to interrupt the work day. If I have to take time off work for labs or appointments, I eat at my desk, making lunch work time.