OK, y’all, a call to vent! I see a pattern in our lives – one of bean counters getting between us and the medical care we need. No, you don’t have to name names if you don’t want to, but I’m interested in a compendium of what you or your doctor would LIKE to try in the quest to get your diabetes under excellent control, but is being withheld, blocked or limited due to the rules or limitations of your HMO or insurance plan. Fire away! I think we all need to see and acknowledge how we are being hemmed in by non-medical decision makers. Do you have any road-blocks? I know you do.
Here’s my list:
1) Gastric bypass surgery – my HMO has some group plans that cover it, but NONE of their individual plans will cover it; several of my doctors (sleep specialists, endocrinologists, internists) have recommended that I have this diabetes-crushing procedure. Gastric bypass is rapidly becoming the standard of care for people with multiple obesity-related diseases, a high BMI and a history of failing at serious efforts at weight loss (I’lve lost and gained over 100-lbs. four times as an adult, twice in medically supervised programs) – but it’s not covered. Even if I raised money for the procedure, none of the post-surgery care or (possible) complications would be covered, either.
2) Levemir – everyone recommends that this would solve some of my problems with Lantus, but it’s not in my HMO’s formulary;
3) CGM – T2’s like me who are having a hard time juggling multiple daily injections of insulin (going hyper and going seriously hypo at seemingly random times) do well with CGM. It helps them solve problems and improve their A1C’s over time if they’re willing to work at it, but my HMO plan won’t cover it;
4) Pump – Having a pump would help tremendously with my fluctuations in basal, bolusing for an erratic eating schedule and need to have very different insulin inputs depending on my exercise schedule. I think I could come a lot closer to flat-lining if I had a little time and help adjusting my dose via a pump. However, my HMO plan won’t cover it.
5) Counseling – I could seriously use some help with handling the severe stresses in my life (e.g. PTSD after an assault last year), my food/eating issues and coping with my health problems (e.g. diabetes-related chronic depression), but my HMO will only cover 12 visits per year with a counselor, and I have to jump through a series of hoops to get those approved. After those visits are used up? I’m on my own, no matter how distressed or depressed I am.
6) Diabetes support group – the HMO doesn’t have one and participation in one outside of the HMO (e.g. one lead by a CDE or doctor)? Not covered.
7) Nutritionist to help with low-carb diet – the HMO will only cover me to see their nutritionists, and NONE of them offer any help or advice regarding a low-carb diet. In fact, if I go to see one I can count on them telling me “eat more carbs, eat more carbs”, even when my A1C was 10.7.
OK, I’ll probably think of something else. Now it’s your turn…