Insurance frustrations

#1

Is this standard operating procedure? I have 1 insurance for medical, a 2nd insurance for scripts and still a 3rd for vision. My diabetes testing supplies are not covered… unless I use accucheck brand…in my area, the pharmacies I am allowed to use under the prescription plan charge @$125 for 50 test strips. My strips are not covered at all but they are @$40 for 50 strips. Vision is a joke. I get 1 annual eye exam and eye glass coverage of $250 every 2 years. As a diabetic I should have eye exams 2x year…not covered. And the piece de resistance…I need an endocrinologist, In network doctors do not have any appointments until November. I can try to have my MD file for precertification due to network deficiency to see an out of network MD at in network pricing ($80 per visit) but I was already told it would be denied unless EVERY SINGLE in network MD in a 50 mile radius has no appointments available within 90 days. The problem is that I live on an island and for me to get to certain “in network” doctors would require me to travel 60 miles to get to a point where I can turn to go another 70 miles to a doctor that is listed in network and only 15 miles away from my home. Yeah, its 15 miles if I am Jesus Christ and can walk the 4 miles across the Long Island Sound. There aren’t any bridges. That trip would be 3-4 hours each way because of normal traffic conditions. Is this sort of nonsense what usually goes on? I am so frustrated. And, my new PMD wants to know why I haven’t seen and endocrinologist yet. It’s been 3 weeks since she told me to go see one. My sugars are getting higher, not lower on Levemir (new med). UGH.

#2

I have no advice for you, just wanted to express my sympathies…

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#3

Do you know if your insurance is HMO plan? They typically have coverage for in network only, with small network. A non-HMO in general will support more doctors, etc.

Yes, its common (in last several years) for pharmacy to be covered by a PBM, such as CVS Caremark. Some plans have different deductibles, some are shared.

For diabetes related eye care (not just glasses, contacts), seeing an ophthalmologist is usually covered under main plan.

Are you newly diagnosed? If not, and are stable, some people find primary doctors that will provide their diabetes care, RX, etc, and may have CDE that help. Maybe there would be someone like that on the island.

Are you taking Levemir only?
If yes, you are likely in early honeymoon stage, but will need meal time insulin to prevent highs after meals. Do you do carb counting?

#4

Ok. I am on an island too. Not the same one as you but an island just the same, with no bridge. There are no endocrinologists here either. I am very lucky that I see a great primary care physician every three months. This is by my own choosing though. I could go off the island to see an endo, but I have really not found that they do anything to warrant the extra time and copay.

I do go off to see the opthomologist. I go every two months for that because I have eye issues.

All my prescriptions come to me via mail order from Optum Rx. I have also used Express Scripts. No local pharmacy will fill my prescriptions the way I want.

I’m very lucky that I have wonderful health insurance through my work. I’m also very lucky that I am the benefits administrator for my company. It’s Blue Cross. If they ever tried to take it away, you’d hear me sqwaking all the way across Nantucket Sound.

Probably none of this helps you. Just another island’s perspective on diabetes.

#5

Please check your medical policy for diabetes related eye exams. Usually optomology visits are covered by medical plans not vision plans.

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#6

I don’t live on an island but I do live in a very isolated area with no endo’s nearby so my local clinic contract’s through telemedicine with an endo. I get my prescriptions from the nearest CVS which is an hour away but if I couldn’t get there I would switch to getting my prescriptions through mail order.

#7

You need to take a hard look at your insurance coverage and understand what is does and does not do. That is step one

#8

Yes, this is common. Have you inquired about telemedicine or a conference call with a specialist?

I agree with @Rphil2 about the eye exam. You need to schedule with a real life optomologist (an MD that gives diabetic eye exams), not an optometrist.

Note: I live just outside a major city and 3 month scheduling was required for my previous endo. My new one is much faster turn around.

Any chance that you know someone with a boat and they could just ferry you across the 4 miles? Maybe the high school rowing team could get you there? Could you purchase a used kayak? “…the average time to kayak a mile is between 20-30 minutes.” http://kayakcampingworld.com/how-long-does-it-take-to-kayak-a-mile/
If you train for the trip and are good at it, it might cut the commute down to 80 min. Depends on the current. But, you might want someone with a motorboat.

#9

These kinds of things are so stressful. Just wanted to mention, I get 100 Contour Next strips for $20 on Amazon and they are working out so well. I’m pretty sure you can get a free meter for those. It’s a real money saver. Blessings to you.

#10

Yes, this is typical and totally worth wasting a full day of travel a few times a year to make sure you get the proper health care and advice you need. Mine is not quite so bad as I live countryside in Massachusetts and it is 90 miles of traffic hell to get to my endo in Boston.

The toughest part is that I schedule my appointments 6 months in advance which is as far in advance as they will schedule and coordinate endo, eyes, etc all in same day at the same facility. Invariably one of the doctors needs to re-schedule due to a vacation, conference or other conflict and I let their schedule coordinator work out the re-schedule between doctors as there are hard limits on acceptable time span between appointment doctor’s notes to be received by Dexcom to meet Medicare requirements. Never easy but they always end up making it work.

#11

Where? the cheapest ones I can find on Amazon are roughly ~$40/100

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#12

Ophthalmologist, ophthalmologist, ophthalmologist.

#13

The price recently increased. My last purchase in Jan was $80/400. I noticed gradual increase since then.

#14

Oh ok, I also purchased some for roughly that price, but in April. Since then, as you’ve also noted, they’ve unfortunately gone up significantly

adasd

#15

They are coming in around $34 now. Was $20. Still for 100 strips, it’s not bad.

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#16

It is not an HMO. It is a PPO. I chose the least restrictive of the 3 plans offered to me. As far as the diabetes… I was diagnosed 4.5 years ago. Am on max glimeperide. It doesn’t seem to do anything. I fired my last endocrinologist because she was not managing me…at all. She kept telling me to take the Metformin that kept me in the bathroom all day and did not get my sugar below 250-300. She said my body would adjust to it…2 years later and did not adjust. My A1C is 11.4. I started Levemir by my new PMD 3 weeks ago. I am now on 30 units nightly and am still 220-280. If I go 3 servings of carbs, I am in the 300s in the AM. The PMD does not feel comfortable prescribing pre meal sliding scale insulin.
I am ready to start dosing myself. This is crazy.

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#17

I appreciate all perspectives. Thank you.

#18

I was on the phone with them yesterday. Waste of time. They said its not covered because I do not have eye disease.

#19

LOL. Thanks for the humor. I have a boat. It’s the docking that may be a problem…

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#20

I have looked on Amazon. I haven’t seen them that cheap. I have the Contour Next meter