Insulin Pump Supplies & Insurance Companies: Short Changed In Translation~

 This post re: Insulin pump supplies and health insurance B.S. is a bit long, but I think it's important & I hope you do too~

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At the end of December and after a string of iffy (and by iffy I’m talking about the sticky part not being so sticking) infusion sets, I called up Medtronic’s Customer Service, told them the issues I was having and provided them with infusion set box lot number.  Medtronic listened to my complaints, sympathized with them and after a series of questions regarding the LOT & REF numbers and infusion set insertion, rectified the situation IMMEDIATELY by sending me a box of replacement infusion sets, free of charge.

1. I understand that things happen sometimes in life and with supplies - I totally get it. 
2. I really appreciated the fact that Medtronic CS listened to my issues & analyzed the problem and sent me out a new box of supplies.
3. The new box of infusion sets worked like a charm. 

Sidebar: Regardless of your pump brand/CGM/test strip/insulin brand, if you’re having issues with anything - you need to let the company know what’s going on. They can’t help you if you don’t pick up the phone. Also, they want to document any issues their customers are having & fix the problem, ASAP.
If you don't tell them you're having issues, how are they going to know and then fix said issues? 

In mid January I received my tri monthly order of pump supplies from Medtronic.
I cracked open the box and instead of emptying it out like I normally would, I decided to get all organized ( my friend Susan Weiner would be proud), took out the bubble wrap and placed the opened box of replacement infusion sets from December in the box, along with 2 extra boxes of insulin reservoirs a friend had given me after she decided to go on a pump vacation. 

My pump supplies were all organized and I felt good.
Every few days I’d reach in the box and grab a new infusion site and reservoir - Easy peesy.
Two weeks ago I had my CDE fax my RX to medtronic because my new RX had been due mid May. 
Cut early last week when I noticed that I was REALLY low on infusion sites - And by low I mean less then 10 infusion sites remained - even after going through all my hand bags and retrieving the spare infusion set I make a habit of keeping in each. 
And I was like: WOW, this is REALLY weird. 
Thursday afternoon I called Medtronic to see when my pump supplies were being shipped and found out several things.

1. My supply ship date is 6/25/14 
2. As of January 1, my insurance company no longer covers four boxes each of infusion sets and reservoirs, only three boxes of each - And now require me to pay a copay for each order. 
3. Apparently, many insurance companies are being "stricter" regarding what a three month diabetes supply actually consists of across the board. So even though I now have a lower monthly premium and the cost of PT or chiropractor visits have been reduced by $5, I have much higher DME copays and deductible - And the number of supplies I receive has been cut by a quarter. 

I didn't actually realized the change in my shipment amount because I didn’t actually empty the box of supplies that I received back in January.

Did I freak? Yep, I did - And I asked to speak with a CS Manager.
To Medtronic’s credit, a CS Manager called me back that afternoon, but of course I missed the call. The CS Manager was diligent and after not hearing from me on Thursday, she called me back on Friday morning and was very helpful. More on that later.

My next call was to my Health Insurance company's Complaint’s & Appeals Analyst (there’s been so many issues w/my insurance that I’m actually in possession of a C & A ‘s direct number and you know I use it), and we talked for 20 minutes. 
I attempted to explain why a 3 month supply of insulin pump infusion sets should indeed contain 4 boxes (same goes for reservoirs,) like I’ve been receiving every three months for the past 11 years, and not the three boxes they recently decided was enough.

I stated that shortening my order was going to cost us both extra money in the form of Lantus and needles. And then I did the math and broke down how 3 boxes of infusion sets didn’t equal a three month supply - And Explained  how the 3-day infusion set rule isn't a given for a multitude of reasons and that wiggle room is need for very important and real reasons. 
Reasons like: Sometimes the sticky part doesn’t stay stuck, how and why scar tissue develops and doesn’t rear it’s ugly head until a couple hours after the infusion site’s in place and resulting in us having to start from scratch with a new infusion site and set. 
I gave her the play-by-play of how doorknobs reek havoc with tubing and the idiosyncrasies of thigh infusion sites.  
I pointed out how SPANKS can not only assist in flattening your belly, but have the ability to kill a brand new and otherwise perfectly good infusion site in less than 6 hours. 
I pointed out that during the summer, many who wear insulin pumps only fill their reservoirs half full because during a heatwave the insulin in the pump can go bad & that it's more cost effective to throw out a reservoir that's less than 1/2 full then tossing 3/4 full one in the trash. 

The C&A knew what an insulin pump was, but she had absolutely no idea how it worked or  all that accompanied actually wearing one - And she was floored. She promised to reach out to Horizon’s Pharmacy Rep and get back to me. 
After our conversation I decided visuals were in order so I emailed her pictures of my current insulin pump infusion belly site and what an insulin reservoir looks inside the pump and next to the pump. 

Photo 1 - Showing exactly what an infusion set site looks like. including tubing & reservoir 

Showing what an insulin pump reservoir looks like next to the pumpSidebar: I'm not a fan of sending pictures of my belly to anyone &THANK GOD I was working out of the house last Thursday & Friday because it was time consuming and I worked until 7pm each night to make up the time.

The C&A called me back on Friday morning to give me an update re: claims that Horizon had finally paid from 2013 (don't even get me started,) and then I asked if she’d received my emails. 

C&A: YES, They actually really helped,  they helped me to understand what you meant when you explained what the supplies did and how they work. I’ve forwarded them to the Pharmacy Rep and hopefully I will have an answer for you soon. 

Like I mentioned previously in this post, Medtronic’s CS Manager called me back on Friday  - And she was great. I explained the situation and how I wouldn’t have enough infusion sets to last me until June 25th. 

I mentioned having to go back on shots and how Lantus had a wicked tail and that I was playing phone tag with my health insurance company to fix the situation and had placed a call into my CDE

The Medtronic CS Manager told me that she’d send me out some infusion sets to help me make it through the week and they would arrive Monday morning. 

And they arrived Monday morning just like she said they would.

So now I wait and keep my fingers crossed. And even though I now have extra backups, I'm being careful with my remaining  infusion sets. 

Here's the thing: I shouldn't have to. 

Yesterday I was running in the mid 180’s all day and I knew it was because of my infusion set. I finally changed it out last night before dinner - And I didn't want to. 

I shouldn’t have to wait, nor should I have to compromise when it comes to my health - both long term and short for fear of running out of supplies. Non of us should. All of our lives and quality of life with diabetes depend on maintaining good numbers - And  personally, I pay a lot for my health insurance in order to do that. 

I don’t understand how insurance companies, who don’t actually understand how pumps and infusion sets/reservoirs work, have the power to determine what three months worth of insulin pump supplies actually consists of. I don't understand why we have to fight for everything when it comes to insurance - But I  know I won't stop fighting when it comes to my health, or yours. 

So have you encountered issues with what your health insurance will and won't cover since January 1, 2014 and if so, how are you dealing with it?