You're not covered any more

so what is your OOP?

Looking back at my records, I pay about $172 for 12 sensors.

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cheaper than mine

Terry–I can only imagine, my friend. That’s the kind of 1/2 hour that can age one a few years. I’m very glad it worked out…Though now that I think of it, I find the possibility of insurance disruptions to be a sort of ostinato of anxiety that underlies one’s whole life at a certain point, don’t you?

We had one that lasted almost a week and it was terrifying. My insurance for 25 years was under my husband’s state public employees plan and was excellent. But I aged into Medicare about a year before he will, so the state had to activate my Medicare (with Kaiser’s senior advantage), still through their plan, while not de-activating my husband’s coverage. Of course my coverage continued uninterrupted while my husband’s was cancelled–which he found out when he showed up for one of those scheduled-far-in-advance periodontal cleanings…Sigh…We got it fixed, but it is a nightmare for so many of us, I know.

BTW (hehe–I keep trying out acronyms as I learn them, though the one that means the most to me is still COIK----Clear Only If Known)----Your description of your process for resolving the issue is clear and very helpful—thanks!..And blessings, as ever…Judith

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OK, Judith. I had to go and look up “ostinato.”

In music, an ostinato [ostiˈnaːto] (derived from Italian: stubborn, compare English: ‘obstinate’) is a motif or phrase that persistently repeats in the same musical voice, usually at the same pitch. [from Wikipedia]

Yes, the uncertainty of the fearful phrase, “you’re not covered” is a repetitive motif sadly played out every day in the US. Our ability to secure coverage and the corporate ability to change or terminate it keeps us off balance and always worried, to some extent, if we’ll have medical access when we really need it. I can’t even begin to imagine the nightmare scenario of a doctor or hospital informing the parents of a seriously sick child that “you’re not covered.”

Some things lose their punch a bit until you are the target.

Thanks for your comment.

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A gut punch for sure - although I do have to admit I like @Judith_in_Portland’s ostinato better.

I am behind you in a similar boat, waiting to see what my retirement from a big company brings when I reach Medicare eligibility in approx. 4 years. Today, I would be covered, but each year has brought either increased OOP costs, or diminished benefits, or both.

In the meantime, I hope you will contact your Senators and Congressperson and request they co-sponsor the Medicare CGM Access Act of 2015. (This link takes you to the DPAC’s letter generating site. No fundraising required!)

This is important for many reasons. Foremost to me is all the T1Ds who are truly in the boat you thought you were in, Terry. But another is as CGMs move toward integration into an Artificial/Bionic Pancreas, many seniors will be left behind without this legislation.

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You’re right, @YogaO. It’s good to write about this stuff, better to take action. I will follow your suggestion. Thanks for the prompt!

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I’m glad this worked out ok Terry, too bad you had to go through all that stress. I was stressed when I accidentally wore my dex receiver into a pool and ruined it recently. Fortunately I had insured it so I got another one quickly. I wonder if there is another way to apply for some supplemental insurance if the access act doesn’t go through? Does your dog wake you up at night if you have a low? I have set my dex to vibrate the past two days because it is annoying and stressing me so much lately and it’s just as loud practically as with sound, lol. The beep for a 50 low didn’t wake me for a while when I slept today. I was about 20 points higher than it thought so all was ok.

I’m hoping that there will be a new, hopefully much cheaper sensor/cgm soon, maybe one that can be worn longer and which is under the skin too.

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Not on Medicare, but I had a similar experience recently after the July 1 Formulary Update at my insurance company. The sent me letters letting me know that my insulin would no longer be covered unless I went thru a “Step program” with Humalog – to which I have an allergic reaction! Despite having that information on file, they were insisting I try Humalog for three months. In addition, they told me that because my Dx is T2D, I would no longer be able to get Dexcom supplies thru the pharmacy, but would have to go thru DME (higher co-pay and separate $1500 deductible) – And would have to go thru an approval process again. Knowing that the DME department already refused my Dexcom twice, i did not expect that to go well. I was left worrying and waiting for the next letter - for my pump supplies…

I contacted my boss and the insurance broker he uses to try and straighten this out. For several weeks it looked like neither one of them would have a solution via insurance (my boss eventually offered to pay for me Dexcom supplies out of pocket if necessary!).

In the end, I got a call from a VP of small business sales at the company who told me to tell my doctor to just put thru all new prior approval forms, and he would see what could be done if anything gets rejected. Amazingly, all the approvals came within AN HOUR of the forms being sent. Since their normal approval process takes 5-15 business days, I have to imagine that this VP intervened in some way.

For now, it all worked out for me in the end, but I am expecting to have to go thru the same process every year. Fun?

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NOT!

This is a perfect example of the “hidden” costs of having a chronic disease. It’s not just the time you, your doctor, your boss, the insurance agent, etc. have to spend, it’s the psychological anxiety; the waiting for the other shoe to drop; the fear that regardless of how well (or poorly) you are managing the disease, that your tools will suddenly be yanked away.

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right now I’m trying to build myself up, steel myself up, to make a call I shouldn’t have to make to my insurance. they always make me cry, and I’m tired and not firing on all cylinders today from lack of sleep.

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Yes, yes yes. Also yes.

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Thanks for the response @meee. Managing the diabetes supply chain is not an immediately obvious burden of diabetes. I have to deliberately control my strongly held sensibilities and deal with front line customer service people who have little authority, often ignorant of the realities of living with diabetes, and a slave to company policies. I have to keep telling myself that they are probably working a job they don’t particularly like and are probably more sympathetic with my situation than they can say. I imagine that many of these people are college educated and trying to pay off onerous college debt keeping the job that pays the bills wishing they could follow their career passions.

The problem with Medicare supplemental insurance programs is this. Almost every policy applies this eligibility rule: if Medicare covers then they will cover, if Medicare doesn’t cover then they won’t cover either. I am lucky that my retirement benefit supplemental insurance doesn’t use this eligibility rule. It covers in cases when Medicare doesn’t. It’s weak in other ways and I do pay a significant monthly premium for this coverage.

My dog wakes me up sometimes when I’m low. He’s not 100%, that’s why I’m a firm believer in multiple redundant ways to insure personal safety with diabetes. It’s why I fingerstick an average of 14 times/day even though I wear a CGM. I can still get caught with a surprise low when all these systems let me down. I still would not give up on any of them, most of all my constant warm and furry partner, Norm.

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@Thas, your persistence (and connections) served you well. The system should not require such tenacity and luck. Glad to read you got the CGM covered. I think it’s terrible that people with T2D are looked at askance when they seek CGM coverage. CGM use saves more money than it costs. Think of the expense of just one 911 call!

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I felt a bit sheepish writing about my short 30-minute bout of fear and uncertainty when I know many of people with diabetes struggle with this all day, every day. My glimpse into that realm was a lot more harsh when it personally involve me!

Managing insurance coverage is tough. It’s a job that I struggle with, too, but I am getting a little better with it as the years go by. I can remember times when I got worked up just working my way through the computer phone maze just trying to get through to a human being. I just kept telling the voice recognition software, representative, representative, representative! The computer would finally get that I wanted a human to talk to and my blood pressure was through the roof. I’ve finally learned to calmly work my way through that. It’s obviously simple but took me some time to remain calm.

Good luck with your insurance call, Marie. I hope you get a good night’s sleep soon!

it’s 2:15 pm here and ive been otp almost all day trying to straighten this out. currently waiting for a representative to pick up. it’s stressing to say the least and the only good thing is ive lost my appetite.

“your call is important to us…”

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I hope it went well, Marie.

I know that every time I have to speak with CareMark, I have to work very hard to maintain my composure. The thought of calling automatically raises my blood pressure.

Oh yeah, the “your call is important to us” dance is maddening. It is important because one of their metrics is “call abandonment”. If it is too high, they look bad to upper management, so they do lots of things to keep you on hold.

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I’m not sure. we used to have good insurance, but the past few years have been a real nightmare.

I think I spent well over 30 hours researching, being on the phone, going downtown for a one hour appointment with a so-called Medicare enrollment specialist (NOT!!!), to enroll in 3 items: Medicare Part B (that required me to go to the SS office twice, and for my wife to drive to another city to obtain a signature from her HR person on a form that SS had given to me), a Medigap policy, and a drug plan. Talking with representatives who don’t always know their business well, and/or can’t explain things properly made the process both difficult and time-consuming. Frustrating doesnt even begin to define how I felt over the course of a couple of weeks of decision making, and enrolling, which is a VERY SLOW PROCESS.

It took so long on the phone that I had to do it using Google Hangouts so as not to exceed my monthly minutes with Verizon (700 a month–I have unlimited data, which means I’ll always have limited talk minutes). Sometimes Hangouts disconnects, which is a pain when the person to whom you are speaking can’t call back, so you have to start the process all over again with someone else.