So last year there I was with an old Medtronic pump and Dexcom Cgm. Life is good. Then at end of year company announces new insurance. Worried I call new insurance company and ask am I going to be covered for all my diabetes supplies and list them off? Answer to each question "Yes, absolutely ".
Well in January, I try to fill Dexcom supplies. Sorry you are not covered for CGM Supplies.
In March receive call from Medtronic "Time to buy new pump - after insurance about $1,000.00. comes with new tester which works to control pump.
Pump arrives (630g) with 25 test strips (Bayer). Take prescription to CVS to fill. Sorry, your insurance does not cover Bayer! Email to Medtronics receives reply that is no help whatsoever.
And to finish my moan, try to refill my Apidra prescription for 90 days and am told your insurance company needs a new justification letter. Gives me 30 day supply.
Just wondering what comes next.
Well I think I feel a little better after writing this.
Yepā¦told me I had to take another insulin firstā¦told them if it worked in 15 min (like the Apidra) I wouldā¦they couldnāt guarantee that and I told them I would hold them personally responsible for my health if I couldnāt get down from >300 after 15 minutesā¦I was approvedā¦use the Walmart strips if you have tooā¦a bit bulky but it worksā¦keep up the fightā¦
Yeah My insurance didnāt tell me that Medtronic wasnāt in network anymore until AFTER I discovered that the amount I was billed didnāt go towards my deductible. Medtronic acted like it was my fault (the woman on the phone actually asked me why I thought they would know anything about my coverage) so now Iāve been waiting a month while the new distributor and my doctor keep missing each other. Or something. No one can tell me why thatās taking so long either.
My insurance has pulled things like this every 6 months when they make adjustments to their formulary. I have been forced onto Humalog twice, despite an allergic reaction to something in it! Testing supplies change with the wind - use this, not that, no, that , not this, etc. My pump was denied, accepted, deniedā¦ My Dexcom is denied every time I need a new prescription - they want me to re-prove that I need it (how many ER visits does that take?).
Finally, last month, they wanted to charge me $3700 (cash price) for my 90-day Apidra supply. THAT, at least, was an error on their part and was quickly resolved (with only an extra 10-day delay in shipmentā¦) Had the CC they had on file had a large enough available credit, the charge would have just gone thru and Iād have had a $3700 problem to fix!
And yes, I think itās going to get worse before (IF) it gets better ā unless something is done to change the entire industry, which seems unlikely.
Unfortunately, it was your companyās Human Resources department or other department/manager who screwed you, not the insurance co. They buy the plan that will be be most cost effective for THEM/THE COMPANY, not you. I had a choice the past few years between a very high deductible and a very much higher deductible plan. At least I know they donāt give a $hit about their employees so I donāt give a $hit about them either. I pay full retail for all of my meds. My last insulin delivery (I have to get three months at a time through the mail!!) was over $2500 - at least I knew what to expect. But until the plan was uploaded at midnight on January 1, I was unable to find out what would be covered or what my costs would be (huh, they went up. Big surprise!!).
Now I travel to buy my insulins. Apidra and Humalog were both under $35 for a box of 5 pens in S Africa, Lantus under $50. (Similar prices in the UK, too). I pay $550 and $350 for them in the US. Most of the time I need an Rx from a local physician (from a dr with a license to practice in tge country I am buying prescriptions in), but they are easy, cheap and may write an Rx a little higher than what I actually need. We are allowed to bring home three months supply for personal use through customs (so itās nice to get an Rx for a little extra). Basically we get free trips!! Iām running a little low on Humalog and wonāt be traveling until June. I hope I donāt have to buy it again before we go!
I use the cheapest strips available through my crappy plan (for me itās Wavesense Presto). The āpreferred brandā would cost me $122/100 (I test 8-12x/day) instead of $18/100 for a non preferred. I use coupons and savings cards whenever I can - I qualify for a $650 rebate for Lantus and know exactly what everything will cost. Unfortunately, I canāt do the same with dr visits and lab tests. I never know what I will be charged until I get the bill. How can a simple visit to my gp cost more than a specialist endo visit? Very frustrating.
The only ok thing is my employer now pays for a Livongo meter with unlimited strips. Itās an invasion of my privacy but free.
Unfortunately, health care in the US is a for profit business. Until that changes, being sick or preventing being sick or just living from day to day as a T1D is going to cost a lot. Or do what Switzerland does - they have for profit medicine figured out a lot better than we do.
Good luck everyone. Itās going to be a wild ride!
The vagueries of medical insurance are truly amazing. Iāve been taking levothyroxin for 35 years, generic not brand name. It has always cost pennies on the dollar compared to the brand name Synthroid. This year my insurance does not cover generic levothyroxin but would substitute the brand name Synthroid for the generic. Huh?
Copay for the Synthroid was $4.38 for 30 day supply. I purchased the generic at retail for $1.27 instead. This transaction must have happened in some alternate universe, because it certainly makes no sense in ours.
In my case, my boss wants to offer the best plan he can for his employees ā within reason. He is paying $30000/year for my insurance and gets pretty bent out of shape when they refuse to cover a necessary expense!
Then your employer should provide a better plan so he doesnāt have to get bent out of shape (but does nothing to change it because he canāt until he chooses the next plan). $3000 is pretty reasonable - I pay more than that in premiums for 2 of us for my $hitty plan. Good for you.
Thatās Crazy for the prices of insulin elsewhere. We are getting screwed here in the USA. I pay $275 a bottle for novolog for the insulin pump and @ 5 bottles a month its pricey!
My insurance didnāt tell me that Medtronic wasnāt in network anymore until AFTER I discovered that the amount I was billed didnāt go towards my deductible. Medtronic acted like it was my fault (the woman on the phone actually asked me why I thought they would know anything about my coverage) so now Iāve been waiting a month while the new distributor and my doctor keep missing each other. Or something. No one can tell me why thatās taking so long either.