Offense or defense?

I spent the entire day today catering to a call from my insurer. They said they wanted me to schedule another Doctors appointment or they wont refill my Dash prescription.

I was just there in July and it took me 6 months of effort prior to that (phone calls every day) to get that dash prescription filled, due to an error that popped up when they switched its classification from “Durable Medical Equipment” to “Nondurable.”

Walgreens is on its knees. The employees have the look of someone aboard a sinking ship. I tried to refill the RX for 3 weeks. I went to Walgreens every day (2-5 times per day). I went to 5 different Walgreens, up to 25 miles apart. I was turned away again and again. I ran out of pods for 5 days. I finally found 2 Walgreens that had dash pods in stock and went to both of them. The second one was able to fill it.

Today the insurer calls and tells me to schedule an appointment. I just had one in July. Scripts should be good for a year. All my Omnipod scripts at Walgreens were “closed out.” I have no idea what that means. So, I spend all day, getting an A1c done, talking to insurers, nurses, Walgreens on the phone in order to schedule ANOTHER drs appointment for later this week and getting them all the data they need. 5 days of Omnipod data WILL be missing because I lost access to the device.

They are makin my life impossible. No one can work a full time job, and have the insurer/provider randomly refusing to fill prescriptions. The fallout is too time consuming.

Maybe I should simply DEMAND that they fill the scripts and that those scripts be 1 year scripts, since I have already done an endo appointment this year. That’s what I would expect unless something really unconventional is going on.

I can’t keep living like this. It would be better to just go back on MI. At least then, I can work 40 hours a week. I don’t know what to do to fix this stuff. They should not be preventing me from accessing my supplies. They should be facilitating access. That’s why I pay them.

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I actually don’t think that an insurer should be strong arming me by threatening to prevent my access to care. I actually don’t think that I should be playing ball with that. There’s something weird about it. They should be facilitating my access to medical supplies. Maybe I have been playing defense for years when I should be playing offense. Something is wrong. I should not be spending all day, every day trying to access medical supplies. I am enabling the medical markets to behave in an absurd way because I know they are broken. They have been broken my whole life and I accommodate their every whim. Their inability to do anything correctly projects onto me. Their inability to function is the entire source of my disability. There is nothing I can do to change the markets from ones that are entirely crippled into ones that supply me much needed, life preserving resources. I aint doing this anymore. I’ll return to manual injection and buy my insulin over the counter at Walmart. I can just refuse to do business with the medical system. There’s nothing they can do about it because I already revoked their power to exercise control over my drivers license when they were not behaving responsibly with that power. All I ask is that the medical system not ruin my life. I don’t think that’s too much to ask. This was the last straw. Now, I am livid.

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I refuse to live this way anymore.

I can have a reliable, predictable supply of what I need for continuous delivery of care if I just go to Walmart and use R, NPH, BS strips and syringes like it was the 1990s. I can have my life back. I don’t have to spend every waking hour negotiating with the medical system for what I need to get through the next day or week or month. I can just live my life.

Would you like some help learning the process your refills go through so when problems do occur it is less work to find an resolve the problem? I remember you having trouble last year too so I’m worried about you.

It’s always a problem to refill scripts. It always seems to fail in a different and unpredictable way.

I’ve come to the conclusion that system complexity is to blame.
I don’t believe that they know how to make it work.

The amount of effort that I go through in order to identify the source of Rx problems and fix it is pretty extraordinary. I do that so often that it just doesn’t seem worth it anymore. Some aspect of diabetes will be harder without tech. But, I think that, overall, things will be better. I know that I can do it. I did it in the 90s.

I have had trouble getting my Omnipod prescription filled. I’m entitled to a 90 day supply via mail order but I have yet to get that after 9 months being on the pod. It’s like the insurance company, and the pharmacy, are doing everything in their power to prevent me from getting what I need in order to live a good life. As you say, we can go back to test strips and syringes with R and NPH hassle free. Why create all this advanced technology if it’s unattainable?!? I have shed many tears over this situation. I just want my omnipods and plenty of insulin to go in them.

We can’t give up. We have to keep trying.

I hear that in your posts so I’m offering to help you figure out the process because then you’ll be able to spend less effort resolving the issues. I think once you know the process it won’t seem complex. Also when the kid at the pharmacy says “call your doc to fix it” you’ll know when they are just trying to get rid of you. Remind me, is your health plan from your employer, ACA marketplace, state medicaid or something completely different?

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Wait till you get on Medicare…they have plenty of rules that aren’t designed to make things straightforward. But we go with it because there’s no alternative.

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Every insurance company I know of wants chart notes from your provider every 3 to 6 months for pumps and CGM. It’s how they know you’re using the equipment. I thought we were all well-versed in playing by the annoying rules.

I literally just went through this myself. My last appointment was in July, so I couldn’t submit my supply order until after my next appointment the other day. Wound up shipping a week late, but that’s my fault for procrastinating.

Well, I could have submitted the order… But I’d have been on the hook for the full cost had insurance denied it.

As much as insurance companies suck, I’m actually impressed they called you to tell you to sort it out, instead of a blanket denial after the bill was rung up.

Dash or Omnipod 5?

I’m on Dash. I was a forced hardware upgrade from Classic → Dash.
I’ve wondered if there is an aggressive effort to force another upgrade onto 5. But I can ask questions like that all day long. There will never be an answer.

I have a privately owned policy. I have never never changed policies EVER in my entire life. I purchased it privately when most peeps would have gotten kicked off after graduation from school. I’m too afraid to deal with a new policy, for fear of even more catch-22s. It’s a great policy…on paper. It’s negotiated by State of MN employees with strong unions that throw fits if anything changes for the worse.

I’ve never seen this. Are you stuck on 3 month prescription? I feel like one year prescriptions are the norm here in MN. I do see the hand of the insurer reaching down in this instance to strong arm me., but they are using the Doc as an excuse. It’s not the Doc. I know this Doc.

The insurer is claiming that I attempted to fill the Omnipod at, “too many different Walgreens,” and that’s why they can’t understand what is broken in the process. They are blaming my attempt to fill the Rx through so many different Walgreens - 5 in total. But that’s because, for a period of 3 weeks straight, 3 Walgreens failed.

The first had a pharmacist leave for maternity leave and one pharmacist retired. When you walked inside, pharmacy staff had the look of people aboard a sinking ship. My dentist had tried to send them an antibiotic for an infection in my back molar. After 6 weeks of trying to fill it, I just gave up. I drained the infection myself using a lancet. It’s still there, but it doesn’t hurt as much. The 2nd one still hasn’t been filled. It was originally written before Christmas.

The last time that I spend 6 months trying to fill this script, Insulet shipped the pods from Fargo to a Walgreens location in the northern suburbs. They had a secret pharmacist there who acted as their “fixer” for problems like this. He was the only one who could fill it. It was like a miracle. When I approached that Walgreens, it appeared out of the fog, over a hill, like it was all a dream. When I went inside, although we had never met, the Pharmacist and I knew OF one another. We had been told the other existed by Insulet and the insurer. I asked him why this terrible prescription nightmare occurred and he said, “No one in healthcare knows why anything succeeds or fails. Why ask questions that you know that no one can answer?” Then he gave me $250 worth of Dash pods for $50. Since then, I refer to that Walgreens as, “The Hall of the Mountain King.” He told me to return to that location if I ever had a similar problem.

Once I ran out of pods, I tried to go to The Hall of The Mountain King Walgreens. It failed to be able to successfully order Dash pods. The magic pharmacists had left the location.

So, I tried the next nearest Walgreens. There were many failures, but finally, I got a superstar tech named Mila. She spend a huge amount of time talking through the ‘hang ups,’ and said there were only 2 stores in the metro that had Dash pods in stock. If every attempt to order them failed, then maybe I could just drive to a location that had them in stock. That led me to the Brooklyn Center Walgreens, where I watched them explain to the man in line ahead of me that, “They had not filled any prescriptions that day, and they couldn’t say when they would again.” Understaffed. The man was irate. I cut in to explain that things were broken all over town and that I had been trying to fill a script for 6 weeks with no luck. I confirmed the existence of dash pods at that location, but given the despair of the staff and the unlikelihood of success, I said I would return later in the day if necessary, but until then, I would drive 25 miles to South St Paul and see if I could get them there. Walgreens customers had realized I was diabetic by then, and cheered for me and shouted well wishes as I left.

South St Paul was a success.

The pharmacy lobbyists in town say that I should not be using Walgreens at all. They say I should be at a small business pharmacy that will do things correctly and fix problems like this.

I’ve been too afraid to try that because those pharmacies aren’t open 24 hours and if I need to stay up all night in the Walgreens parking lot in order to fill something, I simply wont have that option. Recently, I learned that I can probably just have a 24 hour helpline nurse call an RX into Walgreens in an emergency.

I will have the Doc move Rx’s to Goodrich, a smaller, more reliable pharmacy…in the event that helps fix some problems.

I guess that, even though care is inferior, it makes sense to me to have access to SOME form of care consistently. Perhaps I can do that through Walmart, over the counter insulin and BS strips.

At least every single day will not get eaten up trying to access supplies. I don’t have weeks to dedicate to filling a single script. The practical reality of the situation is that I cannot obtain access.

I would rather work a job and live my life than have access to an insulin pump. Maybe someday things will be different. As it stands, me and the medical system are unable to do business. Maybe some day we will be able to have some amicable relationship. For now, there are irreconcilable differences. I have a Doctors appt in a day or two with a Doc who remembers me being on Loop. I need to be able to discuss these impediment without bursting into tears. That’s gonna be tough enough.

This being January/February it seems likely what expired is your insurance-required Prior-Approval paperwork. Almost all outfits run that by calendar year causing mini-crises for us at start of every year.

Its possible. But I just spoke with a nurse in endocrinology at the clinic and she says I am the ONLY user of the dash model that they have had in ages. I am the only one. There may be aggressive efforts to indirectly force an upgrade to Omnipod 5 so they are only manufacturing and distributing one model of pump. I don’t see any problems filling prescriptions for Omnipod 5.

When I started Omnipod 5 I tried Walgreens Community. They got one order right, after that they held up every single order. Sensors and pods. They said it is because they have their own Medicare approval board. It had been about three weeks, no sensors, order sitting there. I went back to Adapt/Solera, which I used when it was Diabetes Management and Supply. Everything was instantly approved. And that was last March, no issues at all. They even mentioned I could get a 90 pod supply for the same copay as a 30 day. Now, they do ask when you last saw the dr. I don’t remember the Medicare rules, but my CDE gets me in in time to meet that requirement. I hate Walgreens. Never again!

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For sure some practices have “preferred” brands Prior-Approval paperwork and even team up with local pharmacies for streamlined tech.

A decade ago Walgreens was SUPERB for teaming up with practices for cutting through paperwork - I literally got my first CGM the same day - but all cooperation seems to have evaporated in past couple years.

My current practice is pretty neutral with regards to tech brands BUT I know they also ask me a lot about upgrading to the newest generation (e.g. G6 to G7) so I think they like having everyone on the same generation. In the case of pump supplies I think the defining factor is the 3-year insurance waiting period between new pumps?

Great! What is the plan name? I want to read the EOB and formulary so I don’t mislead you. I’ll also check to see if they have leaked any relevant policy documents online. If you don’t want to share publicly PM me.

It’s a HealthPartners plan. https://www.healthpartners.com/
Care Type: “Individual Peak”
Group 0057
RxBIN 003585 RxPCN 24002

Is that helpful? I’m not quite sure what your up to, but its interesting.