Oh Yeah That Other Part of Living with Diabetes

May 21st, 2010 by Amy Gonsalves Leave a reply »

I know it’s Friday and all, so I maybe shouldn’t bring this up.  But alas.  I’m going to go there. 

Health insurance.

Yup.  I went there. 

It’s an aspect of many people’s lives, and not a happy aspect at that.  And I’m a lucky one since my husband works for a global corporation.  But they are self-insured so many laws that apply to most insurance plans don’t apply to his plan.  (Some laws that mandate certain coverage don’t apply to self-insured plans; wacky loophole.)

I consider myself an educated consumer when it comes to health insurance, not only because of my unusual ability and affinity to reading the small print (handy for my career as an attorney) but because I worked for more than a decade in a medical front office doing medical billing. 

And yet things change every year.  This year, my husband and I made a bad decision when it came to our November elections for 2010.  That one is costing us several thousand dollars, and it’s only May!!  It is an added stress to living with a disease that seems entirely unnecessary.

My pump costs roughly $6,000.  My pump set of tubing, catheter, and reservoir costs I think $15 per set that I change every three days.  I’m incredibly fortunate that my strips are covered at 100% so I don’t pay anything out of pocket for those.  My insulin cost $360 the last time I filled the prescription (including my deductible; this next refill shouldn’t cost that much!).  And yet it’s an insulin that has worked well for me, so I pay for it

My mail order pharmacy sent a letter today that said they weren’t going to fill my refill request until July 16, 2010.  Um.  Well, that’s not so much an option as I’m on my last vial of insulin.  I can’t wait.  I filled it February 2nd and the box says I was due for a refill last month.

So I had to call them and ask what they want me to do.  Lucky for me, the woman took a look, spoke with her supervisor, and five minutes later advised me that there was a glitch in their system and they are sending me out my insulin.


But I don’t want to avoid the question why an insulin syringe is considered a prescription/pharmacy item but a pump tube is considered durable medical equipment.  They serve the same function and unlike some durable medical equipment like a wig or wheelchair, pump supplies are one-time short term use.  I had a different plan three years ago that considered my pump supplies a pharmacy item.

I know many many others have it much much harder than I do.  I know I’m a lucky one that I have fairly good coverage.   It’s still an added and I think unnecessary stress to have to deal not only with my blood glucose fluctuations and micro- and macro-vascular complications but the administrative side is very simply a pain.

In my experience, we don’t talk much about the administrative side of having diabetes.  I wonder why we don’t.

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1 comment

  1. MaiaJane says:

    Oh man do I feel ya or what?
    I have great insurance..BUT (and there is always a but!) I have to pay 100% of all prescriptions up front and APPLY for reimbursement.

    this is obviously a plan for young/healthy people who aren’t on a frist name basis with every Rite-Aid, Safeway, Wallgreens, Costco, Wallmart and Haggens pharmacist in a 200 mile radius.

    Safe to say, my family (who live out of the US) bring me subsidized insulin from overseas… and I still pay over $300 a month on strips.

    While we are at it, why aren’t foods to cover low blood glucose counted as medical supplies? I shell out SO MUCH or Luna gummies and Sport Beans…

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