So I have been a type 1 diabetic for 20 years and I had great HMO health insurance before moving to a state that rarely takes HMO insurance. I really enjoyed my HMO as they covered EVERYTHING, I never had to fight for insulin or the need to live. Now I have a PPO with Providence Health Insurance and they are master manipulators. They manipulate every cost so that only $5 or less goes to meeting my $5000 deductible. Not only that, they only cover one HbA1C per year. I don’t understand how a person can prevent complications when they only get one HbA1C per year? Furthermore, they demanded 3 months worth of blood sugar numbers while testing four times per day minimum to get a CGMS, yet they only cover 2 test strips per day. I feel like every day I get something in the mail from them telling me I have to cover majority of costs and yet none of it is applied towards my out of pocket maximum while seeing an in provider doctor.
So sorry. I felt the pains of insurance games as well. Hang in there.
The home A1C tests are pretty accurate. They sell them at CVS, Walgreens, and Walmart pharmacies. $40 for a box of 2 tests.
Amazon has them at about $45 for 4 tests.
This does not help your insurance rant, but it is a practical and cheap solution to help monitor your control.
Under my Medicare Advantage plan, my test strips (5/day) are free; however, my sensors ($70 per week) are not covered. Also, my quarterly visits to my Endocrinologist, which includes a blood test covering my A1c plus another 30 tests, costs $10.
Thank you that helps, Im just frustrated with how much they nickel and dime you, their life isn’t on the line but mine it and it feels like a game. Its exhausting.
Good to know
Raina, are you in WA or OR? If so, we might have the same health insurance company. I have nicknamed them Rinky Dink Insurance because they move at a snails pace.
Regardless of if we have the same company or not, I’d encourage you to call them and discuss. I think the one A1c test annually is for the general public…if your doctor or endo orders lab tests more often because you are Type 1 they should be covered. It might take long hold times or many calls to reach somebody who will listen and look into your coverage.
Type 2 here well ontrolled usually under 6.0 but on Medicare advantage, and Even though I usually only do an A1c every six months, the instructions for the lab is that I can do it every three months. Once a year is not enough
Phone, email or write your members of Congress. Ask them if they would want this coverage for themselves or their family. If not, what are they going to do about it.
The 3 months worth of 4 times a day blood tests is really easy to do. I had to do that to get my original pump. I had to show I had low numbers, under 60, low 50’s at least 4-6 times to qualify for a pump. With the test strips, my husband with just a prediabetes sugar issue only gets 2 a day, but a type 1 should qualify for more, but it can be how the doctor submits and writes it? My endo wrote me up for 6 a day and she has said basically they will cover most things with a type 1.
That being said, insurance companies can be very different, and some of their stuff is read overseas and they don’t interpret things right? When I was younger I remember being turned down because they had read I had been diagnosed in the past with cystitis (bladder infection) and they turned me down because they said I had cysts in my breasts. We had to call and appeal that they had it wrong and they reversed the decision. It could be going across the desk of someone that is reading this is what we cover for sugar issues and not bothering to go farther.
A headache that you have to do but do call and if you don’t get a better answer ask to escalate the issue. Who knows what the insurance has down in their records. Or what they really cover.
HMO vs PPO
The only advantage I have seen in a PPO over an HMO is the out of network coverage.
It seems that HMO’s offer better coverage and lower co-pays than the PPO’s that have higher premiums. Makes NO sense.
My PPO allows A1C testing every 90 days, BUT, will reject and deny any claim for an A1C done at 89 days. It MUST be 90 days or more, not a single day less.
My area has much better HMO’s but my docs are not in their networks and my coverage would be ZERO. I am stuck with PPO’s since I refuse to change docs.
I am so sorry you lost your good coverage due to moving to another location.
I don’t know how you solve your situation. I totally understand. My insurance started last June to only approve 5 insulin pens for 90 days when I was receiving 15 pens. What a surprise! I am still working on solving my situation. I also can’t get test strips. I have Medicare part B, United Health Care part B and United Health Care RX. I don’t consider it is Insurance’s place to decide what is needed for my health. It has to do with money and their profit.
Before you started your insurance did you verify the coverage?
I did. Everything has been going smoothing with Walgreens and all my coverage until June of this year. I have no idea what changed. My doctor’s prescription has not change for 5 years. Then suddenly a day in June things changed. I got 5 pens instead of 15. 5 Homolog and 5 Livemir. And in October, no test strips. Tons of phone calls, and I can’t get a straight answer. My doctor showed me what he has written and faxed to Walgreens. I have just change to OptumRX and the same thing is happening. Medicare part B, said my A1c’s were good enough that I didn’t need to test. Things just suddenly changed. My doctor doesn’t get it either. It has been stressful which I don’t need. I have been paying out of pocket for I need. Not fair. It is also scary. Especially when money runs out. There has to be a disconnect and a way to fix this. Thanks for your reply. At least, someone is listening.
Gee, and people rant about so called socialized medicine! At least I didn’t have to worry about any limits on test strips, blood tests, insulin and it’s cost etc. And contrary to what rampant free marketeers and libertarians hold to we don’t get lower costs because our American friends get screwed. We get lower costs because we, through our taxes often fund grants to the big and little drug companies so they can develop these new drugs and improvements and tests in old ones to see if they can be used in newer ways and the give, yes, give the patents to the drug companies.
I had a similar experience a few years back. Apparently, in the insurance companies system I was entered as a Type 2 NOT a Type 1. Once the insurance company fixed that error I got my test strips and stuff covered again. It was a stupid clerical error but caused 30 days of stress.
Walgreens does over the counter A1c’s. Walmart has the east expensive strips I know of - over the counter. Where did you move to? You might have to move back. $5,000 seems pretty extreme.