Insurance - Gotta Love 'em! - ThinnerTimes

Baron Patrick · 12-29-2005, 08:39 AM

I saw my doctor yesterday, and she gave me a present! I'm now a diabetic and have to take Metformin twice a day. She also gave me a perscription for a blood glucose monitor, test strips and all that fun stuff.

Now, here's the interesting part. The insurance approved my medication. A drug I will probably need to take the rest of my life (if I don't have the surgery that is).

HOWEVER, they denied me the monitor. Let's take a look at this. I now need to take medication for diabetes. This means I need to keep track of my blood sugar. Since they denied me a monitor I guess I'll have to go to the lab and have it done on a regular basis.

Let's see, they will have to pay the person who takes my blood, the equipment and materials used to test the blood, and then pay the person who conducts the test. Then another person has to write up the results and send it back to the doctor who takes time from her schedule to call me with the test results.

On the flip side ...

Give me a $100 monitor, $30 for test strips and a few bucks more for lancets. I'm directed by my doctor to test my blood twice a day - morning (fasting), and 1 hour after dinner.

What the hell is wrong with this picture? Why is it the insurance company will spend a dollar to save a few pennies? I guess this is one mystery we will never be able to figure out! I'd love to meet their accountants!

Anyway, I know what the doctor is doing, she's helping me build a case for wls. She also said I need to start doing cardio. Forget any weights, just cardio to strengthen my heart (gee, I wonder if this has anything to do with getting me "in shape" for surgery

). Ahh, but I'm one step ahead of her. My family gave me a mountain bike for Christmas, which I will be happy to ride every chance I get! All I need now is a yellow shirt that says "Wide Load" on the back.

Well, I start weight watchers next month, so will see how that goes. If one person makes an "easy way out" comment regarding wls, I promise I will hurt them! And believe me, I will be smiling!

And so, the saga continues!

peace and blessings

Gina · 12-29-2005, 09:08 AM

The insurance company is banking on you not following through with all the lab testing. Most people who are told they had diabetes ignore it and do not test like they should. I read somewhere that the average diabetic has a A1C of 10!!!!!! I believe under a 6.5 is ideal. Now in order to get an A1C of 10 you HAVE to be ignoring the issue! So my advice to you is to go as often as you can and make them pay for it, not only will it show them their stupid ways But it will also give a record of your readings.

Good luck to you.

Baron Patrick · 12-29-2005, 09:31 AM

Quote:

Originally Posted by Gina

The insurance company is banking on you not following through with all the lab testing. Most people who are told they had diabetes ignore it and do not test like they should. I read somewhere that the average diabetic has a A1C of 10!!!!!! I believe under a 6.5 is ideal. Now in order to get an A1C of 10 you HAVE to be ignoring the issue! So my advice to you is to go as often as you can and make them pay for it, not only will it show them their stupid ways But it will also give a record of your readings.

Good luck to you.

Hi Gina;

Trust me, I'm going to be such a pain in the butt, they will give me what I want just to get rid of me!

I'm absolutely serious about this. I'm going to the doc for anything and everything. I'm going to establish so much documentation there is no way they can deny me! As for the blood check monitor, I will do this religiously - again it's all documentation that can only help me to get what I need.

aesidwell · 12-29-2005, 09:35 AM

What insurance do you have Baron? Just seems so curious that they deny the monitor and strips.

My dad has been diabetic for over 20 years and I cannot think of a time that at least test strips weren't covered (He may have bought his own monitors over the years, I can't remember), and he's gone through multiple insurances (Blue Shield, Aetna, United Health, Kaiser, and a few I don't think are around anymore).

While getting the regular testing at the lab is certainly a way to stick it to the insurance company, most diabetics have to test 2-3 times a day or more, correct?

If it were my situation (and it has been my situation on different illnesses, not diabetes), I would keep calling the insurance again and again saying, "Look bozo, it's going to be a lot more paperwork for you if I die because I was denied a fundamental drug/testing instrument/doctor's authorization that I need to survive, so why don't you get me your supervisor, or your supervisor's supervisor so we can get this worked out, you can go back to screwing the rest of the public and I can live to pay your company another day." Repeat as necessary

Also, didn't any of these companies ever read or see The Rainmaker??

Baron Patrick · 12-29-2005, 09:44 AM

Quote:

Originally Posted by aesidwell

What insurance do you have Baron? Just seems so curious that they deny the monitor and strips.

My dad has been diabetic for over 20 years and I cannot think of a time that at least test strips weren't covered (He may have bought his own monitors over the years, I can't remember), and he's gone through multiple insurances (Blue Shield, Aetna, United Health, Kaiser, and a few I don't think are around anymore).

While getting the regular testing at the lab is certainly a way to stick it to the insurance company, most diabetics have to test 2-3 times a day or more, correct?

If it were my situation (and it has been my situation on different illnesses, not diabetes), I would keep calling the insurance again and again saying, "Look bozo, it's going to be a lot more paperwork for you if I die because I was denied a fundamental drug/testing instrument/doctor's authorization that I need to survive, so why don't you get me your supervisor, or your supervisor's supervisor so we can get this worked out, you can go back to screwing the rest of the public and I can live to pay your company another day." Repeat as necessary

Also, didn't any of these companies ever read or see The Rainmaker??

Amanda;

I've a call in to my doctor, and I'm sure this will get worked out. I have Cigna, and your right, it does seem very odd they would not cover something as basic as this. For me, I will need to test twice a day - morning and evening.

On a side note, I've a friend who is insulin diabetic. He has the same insurance as me, and they approved him for an insulin pump, which by the way, cost about $6,000.00 (he showed me the receipt). His cost - $15.00 co-pay. All I'm asking for is a $100 blood test monitor.

coptergirl · 12-29-2005, 09:48 AM

Baron - I would contact your insurance company again and again until they approve the monitor - it is ridiculous that you would be denied this one piece of equipment that is directed by your doctor. I swear the folks at insurance companies are smoking some crack!!

peacefield · 12-29-2005, 10:37 AM

Baron, did they say why they denied the monitor?

I was just at my WW meeting last night, and right now they are having free registration (at least at my place, but it must be national, right?) so that's cool you're signing up soon! Are you going to say anything to them about doing this for insurance purposes and your hope to have WLS? I thought about that last night after my meeting (I gained 1.5 bls btw - thank you all those Christmas cookies

).

JimJ · 12-29-2005, 10:51 AM

Patrick, I am diabetic. The insurance companies usually will only approve certain monitors. If you call them and ask which ones they do cover then you can get your doctor to write you a script for it. What's bad is none of the insurance companies pay for the same as another. I think it is the way they receive their kickback or incetives if you will.

I hope this helps
Jim

Jtcox88 · 12-29-2005, 11:30 AM

When I was pregnant both times my doctor placed me in a diabetic class. They gave me my monitor and all the supplies. They also billed my insurance for me. I had to test 6 times a day. So, have doctor demand that the insurance has to pay. That's what mine did! Good luck!

Baron Patrick · 12-29-2005, 11:31 AM

Quote:

Originally Posted by JimJ

Patrick, I am diabetic. The insurance companies usually will only approve certain monitors. If you call them and ask which ones they do cover then you can get your doctor to write you a script for it. What's bad is none of the insurance companies pay for the same as another. I think it is the way they receive their kickback or incetives if you will.

I hope this helps
Jim

Thanks Jim -

I did call my insurance and the monitor is considered "durable medical goods". Yes, they only provide two models, one of which my doctor requested. Anyway, this means the pharmacy can't give me the monitor, but can provide the strips and lancets (Cigna changed their procedure/protocol a year or so ago, and now has their own fullfilment division for these things). But they only cost $60.00?? It's not like I'm requesting something exotic!

Anyway, they transferred me to the mail order person who took my info and is sending me the monitor and 3 months of strips (which will take 3 to 5 days). All this for a $20 co-pay. They wanted to charge me an additional $20 for the lancets when I can get them for half that price! Am I surprised? No. I hope their incentive or kick-back is worth it for them!

Another example of insurance red-tape you need to get through. At least this one was easy. I guess I will need to be calling them a lot while I get through all this - which is fine with me!