The Yearly “Fun” Side of Life With Type One Diabetes

April 18th, 2011 by Amy Gonsalves Leave a reply »

My husband started a new job a few months ago, which is fantastic in general, but also a sort of a pain for me a couple months after he starts.

It’s time to choose a health insurance plan.

Which again I should say is a blessing to have a husband who works for a large company that has fairly good health insurance coverage.  (This company “is so good” this one will even provide pet insurance, if you pay for it.)

But the fancy colored brochure and the guy who came to explain the plans to the employees and all of the fancypants HR people employed to help us decide what plan will work best for us don’t really mean much, as they aren’t really helping.

Do you know what I mean?

Sure, I can figure out that if I took Drug X every day and that didn’t change and I saw my doctor once a year and had labwork it would be better for me to sign up for Plan A instead of Plan C.  That would be easy. 

I can even sign into my account at the medical clinic and look up what visits I had, and add up those copays and see how much a pair of glasses or contacts costs and see how much I should set aside in a flexible benefits plan.  I can estimate based on my records and prior year’s expenses just like anyone else. 

But life with diabetes isn’t that easy.

The thing I can’t figure out, mainly because it isn’t in the brochure, is how much they cover for Durable Medical Equipment, or if they cover test strips and how much I pay for either of those.

And, not to ignore the fact I’m an attorney and I did medical billing for eleven years so it isn’t like I don’t know how to read the book.

So I read the brochure and it says “for any other questions contact your HR department”.  I show it to my husband, who dutifully heads to his HR department and asks.  (He asked the guy who came to explain the plans and that guy didn’t know nor has he gotten back to my husband as promised.)

They don’t know.  So, they (which I think is nice) call up the main insurer, who suggests they call the plan administrator, who says it’s different whether it’s prescribed by my doctor or if it isn’t prescribed by my doctor.

Gee, thanks for the help.  (And FYI, I can’t get pump infusion sets without a prescription.  But that shouldn’t change the allowed amount for payment of the code.)

So now I have to go through my records and find the codes for my pump supplies, and find the codes for my CGM, and my husband has to go ask for the specific code payments/classifications. 

I’m serious.  This is what he’s spending his day at work doing today.

Two years ago, I just did what I think most people do, and looked at the prescription coverage and saw it was identical for each option, and I looked at what I actually see doctors for, and I made my best decision at the time.  I didn’t go into the code-by-code analysis.  I tried to simplify things and not treat myself like I needed special treatment.

THAT was a bad decision!  We ended up with some hefty medical bills that year.

It just frustrates me sometimes.  I am a rather healthy and fit person, were it not for this one little thing, also known as 250.01

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