Insurance Horror Stories

Here’s mine (call it being frustrated at things that don’t make sense):

Share yours here.

I’ll share mine here. I get a nice letter from our insurance, which we have had since January that they are looking into the huge claim in May when my son was diagnosed-he was in the PICU, had emergency transportation from a small hospital, etc because they think his diabetes is “pre-existing”. I got on the phone immediately, I was put on hold and the music stopped to say “diabetes is preventable by diet and exercise and you can reverse it by diet and exercise” grrr. The lady comes on and basically calls me a liar, I politely explain to her that I was on tricare-my husband was in the navy-beforehand and if he was sick before January we would have taken him in since tricare is free. I also tell her that there’s no way I could have my son walking around with type 1 diabetes for 5 months untreated without him dying-she seriously doesn’t know the difference between type 1 and 2, I know my uncle had type 2 and didn’t treat it and it took months for him to die of heart disease. type 1 can get ugly real fast.
So after all this, I ask her when I will know if they have denied my claim or not-her response “when you get that bill that’s over 25k you will know if we denied it” If they do we’re getting a lawyer.

I had a very similar issue as Manny.
When my daughter got put on insulin pump we were told to test more, especially in the beginning to get it all configured correctly. So I got a script for 10 test strips a day, took it to the pharmacy where I always get my suppplies in three month increments, got it filled, took it home, and when I opened it, I reliazed they only gave me 6 strips per day.
I had to go all the way back to the pharmacy to question it (plus, they only gave me ONE bottle of insulin for three months, yet they charged me three monthly copays!.. and I got wrong back-up syringes… A whole another story).
The (new) pharmacist told me that insurance refused it and I need to take it up with them.
I called the insurance and they said that there was no pre-authorization from the Dr (what? Prescription is not good enough?..)
I called the Dr office and left a message for them to call my insurance to “pre-authorize”.
Dr called me back and said that it was up to the pharmacist to overwrite the allowed amount of strips.
So, I was back to square one, ready to scream. This time I talked to a different pharmacist, explained what was going on and she said “hold on, let me call the insurance”.
She called them and they, again, refused it. So, guess what?.. She called then again right there, 1 minute later, and they APPROVED it!
I don’t get it sometimes, and I am not looking to the new prescription. I am afraid I will have to do this all over again. :frowning:

I called them because they were requesting more information, my mother in law used to work for an insurance company and she said the doctors probably left out one little word or something in the documents so this is all coming about. Thanx for the advice, my husbands company’s HR is actually great-which is amazing so that might come in handy!

My insurance (sounds like a mountain) originally told me that to get a pump, I’d have to follow the old, outdated Medicare guidelines. My endo told me some of his patients had to run their A1c above 7 on purpose to get coverage. I just couldn’t do that. However, then I moved to Washington state, where the law says they have to cover it without imposing all those restrictions. Many other things are also mandated to be covered.

Apparently insulin pump training is not, though. Last week, six months after I completed my (useless and totally inappropriate, btw) pump training, I got my final bill: $210. My insurance paid $625, so that tells you something. Another thing that kind of galls me is they will only pay $6.70 for an A1c, so I have to pay the other $15. How does that make sense? Don’t they want me to get one?

I know, it doesn’t sound that bad. Well, I get 8 prescriptions per month, for a total of $195. I have to buy additional test strips at $207/month. Pump supplies aren’t bad - $68/month. So our total so far is $470/month plus whatever office visits I have.

Now for the fun part. In my husband’s industry here, everyone hires through temp agencies, so he hasn’t been able to get a position with benefits. So, we’re still on COBRA, which is $823. Final total: $1293/month if I don’t have to see a doctor. Good thing my husband never gets sick (knock on wood)!

Not mine, but a friend’s. Apparently their health insurance covers T2/adult-onset diabetes, but does not cover the diabetes-related costs of their T1 ten-year-old. Their out-of-pocket on supplies and medications (the girl has an Animas pump) is $2000/month. From what their doctors have been saying, it sounds like their school-aged son is going to kick over the line to diabetic within the next year or so, so the costs will double. The girl needs dental work that requires an IV, so it will have to be done in a hospital setting. The insurance company has flat-out refused to cover it; apparently the parents have gone through all the appeals, to no avail.

Has anyone else had issues of a child’s diabetes not being covered by health insurance?