Insurance , Retirement, and Thanksgiiving

Type 1 and LADA
1

Hi All.. I retired in June of this year after 31 years in a school district, at the age of 56. I have enjoyed my continual learning, laughing and learning without job-ties greatly.

Unfortunatety, My MM two year old CGM transmitter died in mid October.Of course, my new insurance, through the retirement system of Ohio, started up on October 1, I had to choose a either a high deductible and lower monthly insurance payments, or a lower deductible and 21/2 times higher monthly payments; All on a reduced retirement income. I chose the higher deductible.
I am not getting BAD coverage, but no where close to what I had before. I am going to have to pay for most of my next few months doctor bills and CGM supplies, and a significant portion of the pumo supplies. MM does not have a contract with the CGM supplier in my local market, so my cost is higher. However, I have a couple of boxesd of sensors to last until February, when they expire..I I am frankly NOT going to be wearing it everyday, just when I am doing stuff out of the ordinary o when on vacation.. I I will be stretching the sensors to 5-6 days if I can
Fortunately, a decent potion of the diabetic suplies and insulin will be PAID at the time of prescrirption order through my Medical Nutual plan with Express Scripts,:They will take care of test- strips, and things to infuse or inject insulin, such as resevoirs, infusion sets,syringes, etc., alcohol, insulin itself,. I am still figurimng out the specific co-pays for each item. Some of the supplies do not have a copay.

Trying to figure out if I should get my insulin delivered to the house by Express
Scripts .Advice?. I have never in 43 years received t mail-order delivery of insulin, and I really do not trust bottles of insulin on my porch on a sweltering Ohio summer or freezing winter. I have been told they were adequately packaged, but I am doubtful. Just so used to going to my neighborhood pharmacie, a CVS, where they all know me and my "scripts".I wonder if the home delivery is worth it.

I now understand why some people HAVE to work to keep good insurance... I am reading about the costs of my supplies and meds without insurance, and I could not survive without having a someahat decent, though lowered coverage plan..

And the info is So confusing..!!! I am literate and intelligent, but it took a lot of reading and research though the insurance start-up books , multiple phone calls. providing a letter of Medical necessity, .and an email to get a new transmitter approval,. I have to pay for it, by the way, through Edgepark., the third party provider( I have not yet met the deductible, but I am lined up for this now that the insurance company and the third party supplier have all my information)
Questions?How could people who are intimidated by such verboisity and confusion even make it through to get greatly needed supplies?? I feel for those who have little children with tyoe one who have to wear the CGMS daily and those who are so hypo unaware that they HAVE to wear it to keep safe.. How could they afford it without insurance.? My CGMS is a considered a "medical necessity" by the insurance guidelines, but what if it wasn't?.

So much for my Vent.. not quite a rant.

I am so gratelul for the life I have today, with both its trials and its triumphs. I am thankful that I now even have access to modern technology to keep my diabetes better managed .After 43 years of Type One, a I am glad to get up each day and feel like I can keep going on to help others.

Everybody, have a wonderful Thanksgiving Day and keep an "ATTITUDE OF GRATITUDE".

God Bless,
Brunetta

2

I have Aetna and use their mail order service. They have usually shipped in a styrofoam box that seems impervious. Every delivery has arrived with the freezer packs still partly frozen. Aetna recently changed to having CVS Caremark provide mail order servicing and they shipped my last Humalog in a package rather than a box, but it came through just as well. So I have never had a problem and don't hesitate to use the mail order service. I also get significant savings.

3

There is no way I would accept mail-order insulin. Ohio is much like Reno, I think? Freezing cold winters and sweltering summers. Except that we have dry heat and cold. I get all my other meds through mail order, but insulin is the exception.

And yes, our insurance "system" is a mess. Why should some people pay more and others less for the same services and meds? People with chronic diseases or special needs, in particular, are slaves to their employers. I just hope you can make do as you have to without lacking any necessities!

Good luck!

4

I don't trust any mail order insulin. I get mine from a pharmacy here in Jackson. That's just me. I'm like u I don't trust the TN hot and cold weather. I have gone a day or 2 over with my infusion sets for my pump but my insurance don't concider a CGM a nessaty so I make sure (or atleast try) to have enough strips to get through til I can get more.

5

I have been getting mail order insulin, 90 day supply, since the 90's. I have never had a problem, including summers and winters. It is in a cold pack and the packs are still cold always. Not frozen but certainly cold enough. My packs have stayed in the mailbox from mid-day delivery until 6 pm or so. Now I am retired so that is not as much of a problem but again, never a problem. I have used both Caremark and Medco.

This includes hot and freezing cold Virginia, Nebraska, and N Carolina weathers.

6

Here in hot/freezing Delaware I've had no problem with Express Scripts shipping of insulin. It comes in a thick styrofoam box, full of freezer packs that are sometimes still totally frozen, sometimes partially. They ship overnight.

The delivery person once left it on my porch where I never look for packages, and I didn't notice it until about 36 hours later. Freezer packs still partly frozen. It's a LOT cheaper for me to do mail order.

7

I get mail order insulin. I get it delivered to a post office box, so I pick it up there. I'm in a rural area so all the mail goes to the post office and we go pick it up. So, in my case, the package is not just left somewhere to sit in the hot/cold. I can reiterate the same as everyone else here, it comes in a styrofoam cooler with freezer packs. I have had it sit for a whole weekend at the post office before I could go get it, and it was still totally cool inside the styrofoam box. I got really sick of standing in line at the drug store every couple of weeks and felt like the clerk there knew too much of my personal business after a while. That's just me, though.

8

I am very lucky. I have fantastic healthcare coverage--will need to pay the premiums when I retire, but it covers me well. However, I am also a cheapskate at heart. I am very careful with what I order and my use of pump and CGM supplies.

Stretch sensors. I have done it for years. It was too hard to change every 3 days, as the change day was not a weekend. Changing at work is a pain.

Insert on Sunday. Wednesday "restart" the "new sensor." Saturday do that again. You will need to change on Sunday for personal safety and the charge in the transmitter dies alomost exactly 7 days after the charging. My pump coach told me (4 years ago) that FDA had approved them for 6 days,. Have not checked the veracity of that, but I seem to be living proof.

I wear pump inserts for 4 days, instead of 3 and have actually gone 5, in a strange emergency situation. I do not have the problem of higher BGs as the insulin has been out longer. Seems to work.

Good luck!!!!

9

I have gotten mail order insulin for 11 years. I also have travelled.
Medco could not change the address after the MD had done his initial faxed order, and he did it without consulting me. I changed to someone else. Either I control where my drugs are or ain't no one else gonna do it.
I have had syringes, 2 types of insulin, and strips setting at one address and me 3000 miles away. Medco would neither stop the order (done on their time only) nor change the address on that first order annually.
SO, if I had my own way, I'd keep the MD from faxing to Medco. Not having my own way, I get separate written prescriptions for each item so that I can get enough when mail order has delivered elsewhere.
When it comes to refills, if dealing with a mail order firm, do it online on Sunday night. Then you won't run into deliveries held over in the warehouse over the next weekend!

10

Happy Thanksgiving to all!! I really appreciate you taking the time to reply: bsc, Natalie_c.-, Doris D, Nell ,jrtpup, Cinderfella, T1Forever, and Leo2: You all gave me various insights and information gleaned from your own experiences...I am grateful and thankful to you this weekend, as your kindness will help me to make better decisions in safeguarding both my health and my purse strings..Have a fabulous weekend .
God Bless.
Brunetta

11

My husband and I are 60 and 61 and self employed. The high deductible is the only insurance we can afford on the individual market. We currently have a $6,000 deductible for $1000 a month. I am trying to work with Anthem to raise the deductible to $11,000 and lower the premiums a few hundred dollars. I know it is a pain. I find that it is a lot cheaper to buy strips on Amazon. I can usually get my Bayer Contour strips for $42 per 100. If you have Amazon prime there is free 2 day shipping too. Any med that we use that is not generic we buy in Canada at Northwest Pharmacy in British Columbia. We do everything on the Internet and fax them the Rx. Also when you schedule diabetes appointment make one a physcial. Insurance has to cover physicals and diagnostic tests for free but will charge you for regular diabetes visits. I also have switched my diet around to keep bgs much lower to prevent complications since I can't afford them.

12

Jeannie, It has to be difficult to be self-employed and diabetic. YOU are to be commended for all you are doing to ensure your health care.
God Bless,
Brunetta

13

Guess What?
this was not quite true: my quote from the initIal Post Fortunately, a decent potion of the diabetic suplies and insulin will be PAID at the time of prescription order through my Medical Nutual plan with Express Scripts,:They will take care of test- strips, and things to infuse or inject insulin, such as resevoirs, infusion sets,syringes, etc., alcohol, insulin itself,. I am still figuring out the specific co-pays for each item. Some of the supplies do not have a copay.

That was what I wanted it to be. Ended up buying a new transmitter out of pocket in Nov. for full price.. It never worked,and I just got a new one from MM yeterday. I will have topay full price for sensors at $300 a box until I meet the $1500 deductible. The price I paid in December( $543)
for the never-used yet ( it was broken) transmitter, was on last year's plan..GRRRR. I am thinking
I will ONLY use the MM sensors (I have a few that do not expire until the end of March) on rare occasions. maybe by then I will have met the deductible. My insurance will pay 80% after that.
I may just put the use of a CGMS on hold until my pump warranty expires this year.

The revised Animas model with an included CGMS looks better and better. Is it to be combined with a Dexcom? The MM sensors are only occasionally accurate, quite temperamental, and I find them difficult to insert with the last two lots I received.

Any thoughts, Kind tu Friends?

Have great Sunday!!

God bless,
Brunetta

14

Yes, it will be the Dexcom integrated with the Animas Vibe. Those in Europe who already have it seem to love it, I can't wait. I will miss the meter remote though for those times the pump is hidden away and not stuck on my jeans.

I also have Express Scripts, and am dreading Medicare. I'm 61 but already stressed about it! All I can do is hope things change by then. I really don't want to have to go back to setting the alarm for during the night to test BG *sigh*.

15

Good for you Brunetta. I on the other hand will never be able to retire because I don't have a real career nor do I have Insurance. Without the hope of a cure paid the Government no matter how you slice it I am F*****D. Had my parents been informed how important it was for someone with diabetes to get into a stable lifelong work environment maybe they would have pushed me in school which I hated anyway. At this point my education is probably equivalent to someone in second grade so I wouldn't dare step into a classroom. I come from a family where there was no education or motivation to do anything more then just pay your bills to survive. Now and for the rest of my life I will pay the harsh price.

16

Thanks for the information and the response,jrtpup. I ,too, hope that in 8 years, when I am eligible for Medicare and will have to use it as a primary insurer, that I will be able to access coverage for both the insulin poump AND the CGMS.

I do believe that as texchnology advances, pump/CGMS coverage will be standard insured treatment for insulin dependent diabeet.There will probably be be other significant advances in closed loop system I also have hope that there my be advances in research towards "cures":Dr.Faustman's work with BCG to induce beta-cell regeneration, stem-cell research, islet cell encapsulation. I am just trying to "keep hope alive" that I will be able to get a CGMS THAT WORKS during 2012.
But it will happen when it is supposed to.

God Bless,
Brunetta

17

Hi Gary, sweetie you do not HAVE to "pay the harsh price" of coming from a family of people who do not have formal education. I am sure your parents did the best they could. You are not alone in that situation. I know and have read about several people who came from very harsh family environments, yet were able to get out of those circumstances and their negativ, self0defeating perceptions and get an education.. They did have mentors and self-motivation. Do you have anyone who could encourage you and that you could use as an examole, a former teacher, coach, a pstor?. Can you possibly take a courses or two at a communicty college with grant money? You are so very smart and I know you can write down your feeingd snd goals, csn show uo to let others know that you are so very interested in contiuing your education for career advancement. You have intensively researched diabetes..Why don't you intensivley research how to get the education you need to get a "real career'. YOU CAN do it. Thanks for responding

Do take care
God Bless,
Brunetta

18

Brunetta, which kind of CGM do you use? I have a Medtronic, which works reasonably OK for the 3 days that they recommend, but that's an awfully short time for such an expensive bit of equipment. It's also not THAT accurate, because for me, it missed 4 hypos in the 50's between August and November. Fortunately, I was awake -- felt 2 of them, but was surprised by the other 2 when I just happened to test. And it wasn't just lag time -- the CGM NEVER showed anywhere near the dip that my meter showed.

I hear a lot more enthusiasm for the Dex, but I know that they have their troubles, too. It's like being between a rock and a hard place!

19

Natalie,I also use a Medtronic...Same issues as you. I am NOT hypo-unaware; and can usually treat without help. But I really want to catch a drift toward highs when I need to ...Many times the CGM is right on the money, but often it shows me extremely inaccurate results as to whether I sm in range, high, or low. I find it to be a major ( do excuse my language) PITA and I would rather test multiple times per dsy than deal with its inconsistencies. Also Kind of "pee-ohd" that the $543 kind of went down the drain.. I guess I just did not think and bought it too close to the end of the year. I had just started the new post-retirement insurance in OCT.;with a 2011 $1500 deductible and had to restart the deductible in January 2011. Hindsight is ALWAYS 20-20. lol

I am due to get another pump this year and the Dexcom/Animas combination, to come in this spring and summer if the FDA approves it.. sounds promising.

God bless,
Brunetta