This is the situation.
I was on medicaid low-income-adult status for a year.
In March, I was approved for my insulin pump (after fighting doctors and insurance for 10 years) and it was paid in full by medicaid.
At this same time, I was fighting the private health insurance company who was trying to exclude me for a pre-existing condition… (at my full time job, which I’ve held since December, in my field of choice, so no, I don’t want to quit it just so I can go back to being a welfare case.)
I was eligible for the private coverage as of March 1st, and when they FINALLY approved me sometime in May, they claimed they would backdate coverage to March 1st… rendering the pump being paid for by medicaid “secondary”… and now the diabetes supply company has to “rebill” the private insurance for the pump. (around $10,000 according to retail)
THe problem here is that the private insurance has a $1500 limit on durable medical equipment for the whole year. So that’s exhausted if the private coverage stays in place.
Infusion sets, reservoirs and test strips are around $500 a month. I cannot pay this out of pocket, and I have to meet a $9,000 deductible if i want the state to help me out again.
What do I do?
I have about 300 dollars a month to spend after all my bills, and that is if I don’t buy myself food or gas.
I have considered just basically not eating, that way I can take way less insulin. I mean, I’d eat enough to stay alive but just enough.
I am at my wit’s end. I already feel horrible, depressed and guilty that I am a burden on everyone around me.
What do I do?
This is the situation.
Oy! Can you just ask them to have you start on the insurance the first day of the next quarter? It probably won’t work but it might be worth a try.
Take a deep breath - people love you,
What still_young_at_heart just said.
Please don’t give up we still love you!
I would call the pump company to see if they have any assistance programs. I went through a phase of no insurance and they helped cover me for a short period of time. Otherwise, I think it would be cheaper to use shots.
People love you and diabetes is cool!
I can’t go back to shots. It wasn’t working. My A1C was over 12 for 8 years.
Were you ever able to see a diabetes educator? Don’t get me wrong the pump is amazing but your health also involves your mental health too. I remember when I was on food stamps etc. and it was one of the most stressful times of my life.
Are you going to check for assistance from your pump company? I have medtronic and they offered to help.
i thought my mental health was pretty resilient until I was made to feel like nothing by the insurance system… Is it really my responsibility to have to give up my full time job to find something “better?” just to have better insurance? is that really what it’s come to? i just called medtronic and they referred me to their supply division which isn’t open until tomorrow, but i doubt theyre going to help me because at a whopping 19,000 a year, i “make too much money”. corporations usually are very selfish.
God I hate insurance companies
They make no sence what so ever do they Jim???
Go to the pump rep. The rep is going to want you to get that pump because they get paid if you get the pump. I would avoid the supply division but rather just ask for a rep an see if they’ll work to get you one. Go in fresh - as if you are trying to get approval for a new pump. The rep should work with the carrier on your behalf.
I already have a pump, I need the infusion sets and reservoirs.
i have group coverage through work that went retro. they don’t exclude the diabetes supply in the coverage limit. they went out of their way to discourage me from joining when their attorney told them they couldn’t deny me.
i have a form of state medicaid that i am on a spend down on, which is the deductible derived from the difference in maximum allowed income and my actual income. 1200 a month x 6 month period of eligibility = 9000. when i hit that, they’ll cover me secondary until october (end of 6 month period) connecticut insurance is completely ■■■■■■ up…
if you are not a poor, single mother or a drug addict OR wealthy, you’re left out of getting any help… even if you can’t afford private insurance
what i’m saying is they DO limit the diabetes supplies. it’s not good insurance. it’s a plan through a union fund.
Please don’t let them screw your mind. Just because the corporate yahoos are heartless doesn’t reflect on your true value. See what Medtronic says, but also check with the ADA to see if you can get any advice on dealing with your insurer from a legal standpoint. Is there some specific reason the insurer MUST backdate the policy’s start date? Who makes the decision as to the policy’s start date? If it’s the insurer, I’d fight them on it. If it’s your employer, then ask your employer to dictate to the insurer to start the coverage May 1 so it works in your best interest and not against it. If you were approved for coverage in May, then maybe you can convince them to begin the coverage May 1 – AFTER your pump was paid for. In the window of time between your eligibility date and your acceptance date on the private insurance, Medicaid was your only option for payment – it seems like an ex-post-facto bait & switch to say, “Oh yes, Medicaid will cover this… but, oh dear, now you have insurance, no it won’t, we retroactively insist that you are covered somewhere else.” That simply doesn’t sound legal to me! But I’m not a lawyer, so what do I know – point is, you should see what your legal position is and try to work it to your best advantage. I’d call the ADA and see what they suggest–I believe they have a legal help line.
Lynne, they can do that now! My company switched insurance companies this year and I am list as having a preexisting condition. My co-pays and deductible are much higher then other coworkers. I called the company and that was the excuse they gave me. That my company that said that as well as the insurance.
Florida, Thanks I will look into that!
You are not a burden. It’s not your fault that the system is as screwed as it is.
In the midst of it all, I recommend looking at the Patient Assistance programs listed on this page:
I hope this helps. In the meantime, please know you are NOT alone. We’re here for you!
Please don’t feel sad and victimized by this. Get angry and fight. The insurance company wants you to just cave in. Don’t do it. You probably have “right” to get all this stuff covered and they are just denying you to see if you will go away. Well you deserve it and they should cover it. Insurance companies and even your own company just tell you no so they can save money. Don’t for a minute think that an insurance company exists to help you, their very existance is so that they can scr*w you. Fight tooth and nail. They will tell you no. They will tell you no again. Don’t give up. Be persistant. In the end, the squeeky wheel gets the insertion sets and resevoirs. I am rooting for you.
Call the pump company and see if they can offer any assistance or work something out with your insurance. Remember, they have a vested interest to keep you on the pump and off MDI because that’s more money for them! They tend to know all the ins and outs of insurance companies and can sometimes work magic.
Also call the American Diabetes Association and see if there is anything they can do. They too may have some sort of assistance program. Check dLife as well.
I don’t know when you were diagnosed or how old you are, but when I was in my early 20s, I was able to get lots of free stuff through our local Children’s hospital (where I had been a patient for many years). I didn’t have insurance in college and would have never been able to afford the insulin and supplies I needed without that program. They covered me through the age of 24.
Your endo may also have some ideas of where to get free or discounted supplies. On more than one occassion over the years my endo has hooked me up with free stuff, especially when money was tight during grad school.
Check with the state insurance commission to see if something is amiss. I didn’t think that diabetes supplies were ever subject to a deductable, but I could be totally wrong about that. Sometimes just a call to them can uncover something that you didn’t think to look at.
Call your state senator/congressperson and let them know that this is what happens. Sometimes the squeaky wheel gets the oil. At the veyr least, they need to understand that this is what we T1s have to deal with just to freaking SURVIVE!
Finally, remember you are not alone. There have been so many times over the years that I have literally been reduced to tears by an insurance company (not to mention the blood sugar spikes that come with the stress of having to deal with insurance). Even thinking about it right now makes my blood boil! I too have had crappy insurance and no insurance. There was a time in my life when I actually rationed my insulin to make it last longer because I wasn’t sure when I would be able to afford more.
Don't for a minute think that an insurance company exists to help you, their very existance is so that they can scr*w you.
bsc, isn't that being a bit too cynical? Insurance companies are in business to make a profit and to provide valuable services for their customers. Those companies choose to be in that game, and they have established sets of rules (contractual agreements) in which both the insured and the insurer must abide.
Indeed there are some greedy and dishonest insurers and claims reps; however, it is unfair to broad-brush the entire industry as being unscrupulous. I have been covered by some less-than-stellar insurers in my day, but I absolutely love my current insurance company. Over the past few years they have bent over backwards to take care of my health-care needs and to create a sense of goodwill.
That being said, I agree that Sagwabetes needs to be persistent, and she needs to keep her employer and the insurer honest. She has a good case to force to her company's private insurer to cancel that backdating nonsense. Insurance is for future protection coverage, not for covering the past. If the insurer refuses to do the right thing, then she would do well to get an attorney involved. It would be money well spent and would be a heckava lot cheaper than $9k in out-of-pocket expenses.