Insurance is painful

Thought of that, but they are saying the HMO is blocking the use of the card or at the least, throwing very little assistance into the price.

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Well, there are if’s and gotcha’s with everything. The HMO can’t block using the card unless the HMO is a government, state, or federally-funded medical or prescription benefit program, including Medicare, Medicaid, VA, DOD, and Tricare. For example, if this is an HMO add-on option on Medicare, you can’t use the card.

Or, if the HMO requires you to use the HMO pharmacy - the pharmacy may not participate in filing the forms to be reimbursed. However, if you have the option of using other pharmacies, then I would take @El_Ver’s advice and switch pharmacies.

Correct. But Novo pays a maximum of $100 per prescription, per month. As an example, if the off-label cost through the HMO is $260, Novo would only reduce the price to $160.

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Hi Dave,
I saw one of your posts that said Medicare pays 100% of your CGM supplies, I was wondering which plan /carrier you have?
Dan McNeal
Scottsdale, AZ

AARP United Healthcare. Between Medicare and AARP coverage, it’s 100% coverage.


Looks like you just need to have a talk with your Doctor to get the insulin type sorted out. Shouldn’t be that difficult.
My experience, with High Deductible plans has been that the deductible is partially offset by the lower premiums. After the deductible is paid, the coverage level is typically better than regular plans. Pencil your total cost, for a year and then compare. Then, you’ll know how much to budget for next year. In my case, the HD plan was significantly cheaper than Medicare, by about 40%.

I now have to waste my time attending a phone conference call hearing with the HMO grievance board to state why I want a tier lowering. So stupid. It should be a no brainer.

I am my GP’s only patient that used Apidra, so his nurse run to get me 2-4 samples of Apidra every time I see him. Not enough to meet my total needs, but enough to make sure I won’t run out waiting for prior authorizations…


I’m curious as to why you don’t see an endo

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Oh, I see an endo, but my endo rarely gives me anything :slight_smile: I see my GP for most non-diabetes things, though. Endo appointments tend to be more focused and short.

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My Endo provides Samples but not on a regular basis, except for a high cost Cholesterol drug she wanted me to try. Doesn’t hurt to ask - the drug reps are always giving them product to hook a customer.


My endo gave me samples of (that) high-cost cholesterol drug he wanted me to try - and is trying to get me more samples, while he fights the battle with my insurance company…

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I won my case. Managed to get tier lowering for my Novolog after attending via phone, a second hearing with the HMO and after filing with the state board. For now my Novolog is affordable again, but only until next year.



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Got to be a PITA traveling to doctor office to pick up the free (otherwise expensive) Cholesterol drug. Printed out Walmart’s list of $4 generics ($12 for 90 day) and requested script of one that would have same results - no argument. Wasn’t d/t Cholesterol being bad but rather as a side benefit organ protection.

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At least my endo’s office is on the way to work…

My endo would be HAPPY to (and has) prescribe one of the inexpensive cholesterol meds - the one of those that he prescribed would cost me a copay of exactly $0. My problem is that I have a family history of serious side effects from statins and the few times I’ve tried them, I’ve had pretty immediate similar issues.
He also tried a med in the “in-between” range, but that one did not help me much and caused me problems.

So… I’ll go get the samples and hope he gets it approved – he hasn’t given up yet!

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Thank you for bringing this up. Have been having many difficult situations since going on Medicare in December. Medtronics has been helping me with the infustion sets/reservoir approvals…still don’t know why that has been such a big deal! Your experience is very helpful to me. Also, happy for your getting some things resolved. Only being dx’d T1 about 4.5 years ago, retirement has been less than enjoyable…bwhahahha and *&^%$!

Iam new so I should learn a lot. I use to be on a group plan for 20 years. Now my group plan paid for both my insulin pumps, 530g,670g. No copays. When I left my Job due to Diabetis I stocked up on humalog 15 bottles,4 box’s test strips,ECT. Now trying to get a insurance plan through Mn sure market place.( I am trying Relion R in my 530g pump seems to be working a bottle cost me 24 dollars at walmart.)

That sounds rough, @motoracer. R is certainly better than nothing, but far from ideal. Can I ask why your diabetes caused you to have to leave your job?

Forgive me with a rant. I am out of sensors and insurance is wanting dr notes. They want to know how many times I test a day. I finally got a little snotty with the lady and explained that the reason I have a cgm is so I only calibrate every 12 hours. It is like talking to a fence post.
What do others tell their insurance? Do you say every 5 minutes or every 12 hours or tell them something else. I am still without sensors.
Thank you

I don’t tell them anything. The doctor’s chart notes has all of that info. You shouldn’t need to speak to the insurance company directly. You should be contacting your doctor’s office for Rx’s and they send it to the appropriate vendor (pharmacy, etc).

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