Tuesday, June 17, 2014

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~
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 workI’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? 


Jenn said...

After reading this, my last supply order was a dream. I try to refill my supplies every three months, no matter how low I am because I feel more comfortable having no shelf space in my closet than not having enough supplies in case all crap hits the fan. I've always been able to get four boxes of both sits and resevoirs. My last order before the end of my policy year I try to push it to 5 boxes. That gives me a little more wiggle room/time to meet my deductible for the new year. This last order I tried that exact thing. However, I was informed that actually my insurance would only cover 4 and a half boxes every three months. Now I don't know if that has always been the case and my third party supplier thought it silly to open a box so they just sent the whole thing, or if this is a new ruling. Either way, I can guarantee that this next year I will make sure EVERY order is the full amount I can get... available shelf space or no.

Unknown said...

Prior to August 1st, 2013, I got my supplies from Medtronic. They told me about the "your insurance says you can only get 3 boxes every 3 mo" problem. However, they did let me know that they could just fill my refill order a month early so that I wouldn't be without supplies and to call them when I had a box left, they wanted to make sure I didn't totally run out.

However now my insurance has forced me to get everything (including new devices) through Edgepark and Edgepark says I can get 4 boxes every 3 months if I want to. So I am not totally convinced that it's an insurance problem. Maybe a insurance-contract-with-Medtronic issue.

Joanne said...

There isn't enough room to list the issues we've had. Fred's company was bought out in Feb. and we changed insurance. Our old plan was great, but I could see signs of them starting to tighten up. The new plan has been a nightmare since day 1, including trying to even find a company who could fill Elise's pod RX. It was a nightmare and we missed three shipments. I was on the phone with them almost every day for a month. Then we moved onto a fight about her test strips. That one also took a month to figure out.

I wish I was as organized and relentless as you. Frankly, I don't have the time for this BS and it exhausts me. You should hire yourself out as some sort of advocate to deal with insurance companies... You'd make a killing!

k2 said...

Jenn -
Thanks for your comment! I always get my orders filled on a tri monthly basis - I was just a few weeks late getting my 2014 RX filled.

Erika -
Thanks for your comment!
Personally, I've had good luck with Medtronic and terrible issues with my insurance company:
So I'm leaning towards the issue being with Horizon BCBS - But if I hear something different form my C& I you'll red about it in a follow up post.

Jim said...

Well, welcome to the brave new world of a messed up health care system in transition and going to get worse.

My health care insurance last year was great but this year it, well, sucks. My costs across the board have gone up. What I pay for the insurance, the cost of meds, co-pays for doc visits and deductibles. On top of that I have had the same issue with what the insurance company thinks is an adequate supply.

To say the least, I'm pissed!

I work for an enormous bank, I will call it "the bank for banks" as we handle all the other big banks money. One of my friends works in the HR dept and said that the changes in our health care is directly due to Obamacare and our benefits will be even worse next year.

I am now at a point that I have not filled my Lantus prescription as I can't afford the three month supply (which won't last three months) and the insurance company won't bend on allowing me to buy a one month supply.

Did I tell you I am pissed?

I'll shut up now because what I really need is my last year's insurance and an enormous soap box!

Kari said...

Maybe I'm in the minority here - but my husband and I are paying less per month for insurance this year. We are also paying less per month for my RXs. And despite having issues in the past, I've had zero problems with supply orders this year. They even approved my new Dexcom with no hassles at all.

StephenS said...

Hi Kelly... My real issue since January has been with my prescription plan's major change in their formulary list. For those that don't know, everything on the formulary list has cheaper co-pays than similar items not on the list.

In my case, it means that instead of paying $60.00 every 3 months for Novolog, I now pay $180.00 every 3 months. Same for my test strips (Accu-View).

These changes are more than likely due to the fact that the makers for these (Novo-Nordisk & Roche) couldn't strike the same deal with the provider that they had last year. As a result, the prescription provider now wants to direct me to Humalog insulin and OneTouch meters & strips because they're making a better profit on those items due to the deals they cut with those companies.

Sorry for the long comment, but what really bothers me here is the fact that money is the motivator for my provider, rather than people. There will never be a time when that's okay with me.

Laddie said...

I am lucky that I did not have to switch insurance this year. My high-risk pool insurance in Minnesota will continue through the end of 2014. I have noticed no changes in coverage this year. I am very worried about 2015 when I will have to purchase insurance on the MNsure exchange. Sometimes I wonder what they think we do with the excess supplies that they seem to think we are getting. Yes, sometimes we hoard extra supplies. But if we knew that we would always have access to what we need, there would be no need to hoard.

Teresa Borders Wright said...

I made the mistake of not reading one of the many letters I receive from my insurance company and found out at the last minute that my world had been turned upside down. Effective January 1, I was no longer allowed to get insulin from my local pharmacy, and was forced to use a mail order company selected by United Healthcare - Optum Rx. Sorry, but the only appropriate words are: They both SUCK. Prior to January 1, and for the past 15 years or so, I have received three vials of insulin per month from my local pharmacy. The pharmacy is exactly 1.5 miles from my home, and is conveniently located between my office and my home. The lovely people who work there seem to genuinely CARE about ME. They have been incredibly kind to me for many years, and I have developed a wonderful relationship with them. Now, I receive only five vials of insulin for a three month period. And I receive it via overnight mail, in a huge styrofoam container with three ice packs. It only took me approximately 2-3 hours of phone calls, most of that time spent on hold, to get set up on this glorious new program. They don't care that I am freaking out at the reduced amount of insulin; they don't care that the styrofoam container takes approximately 500 years to decompose; they don't care about the fuel used by the airplane, or ANYTHING ELSE as far as I can tell ... except that it is cheaper for them. It is incredibly discouraging, to say the least.

Brenda C. Boylan said...

I am a new mom to a teen with type 1. She was diagnosed in August '13. It has been difficult for both of us to say the least, but one thing I didn't expect to be so hard was dealing with insurance companies limitations on covering supplies. I figured, "She's diabetic, she needs this stuff to LIVE, they will just give us what we need!" It has not been that easy and it makes me so angry. I have to fight with the insurance company every month about covering her needles (she is still on needles and vials for now). They say we only need 2 boxes a month, but we always run out RIGHT before they will refill them and I have to call and tell them this EVERY MONTH. Last month she broke her bottle of Lantus accidentally. I called figuring, there must be a safeguard in our plan to cover accidents. Nope, I called and spoke to the rep at the insurance company and he said we can't cover a replacement because it isn't in your plan. I was so mad, and hurt but I forked over the $250 because she needed it and after I did that I said, NO THIS ISN'T RIGHT! We pay too much every month to have insurance to cover for things like this. So I called them back and literally threatened to sue them if they did not cover the Lantus. I told them this is not an allergy med, or some pain medication, this is INSULIN, and she will DIE without it. If I didn't have the money to pay for it, she would end up in the hospital costing your more money and then I would sue you and a lawsuit would cost more than covering the medicine. After putting me on hold for A LONG TIME, he finally came back and said they would cover it. I was thankful, but also really angry that I should have to do that at all. I am so disappointed with our insurance companies for not taking care of their most vulnerable patients.

Anonymous said...

I had a similar issue with insulin pens last year. I need two boxes of Humalog to get me through a month. My prescription dose says 18 units per meal, which mathematically equals exactly enough for one box. I had been greeting two for years, when someone did this math and started giving me one at my pharmacy. Obviously, we all know that he standard dosing does not account for corrections. So my pharmacist (who I love) advised to have my doctor write the perscription to include the standard dosing and indicated for extra insulting as needed to cover for high blood sugar. A simple call to my doctor corrected the issue and I gott my two boxes back. I am wondering if something similar to this would work for you as well?