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? 

"Things That Make Me Go Hmmmmm?" Spring Edition

Spring has sprung and once again, lots of things are making me go Hmmmmmm.

PART 1

I’m happy the healthcare reform bill passed because I strongly believe that every single person (pre existing condition or not) needs to be insured at a fair price regardless of their job, or lack of one.

I've also had my own insurance issues as of late and know first hand what it's like to be forced to switch to a more expensive insurance or be dropped completely by your insurance company because of an out of the blue health scare that was none diabetes related.

Look, I still have questions regarding the health plan. There’s a lot of verbiage to plow through and I haven't plowed through all of it yet. I know it's not perfect and I never expected it to be. But things need to change regarding healthcare and insurance companies and it's a start. I’m still reading articles on the subject & will state my thoughts in a much more articulate manner very soon.

I don’t understand why people are so against having the option of a national health plan, if only for the following two reasons.

Insurance companies will finally have to be accountable for their actions- just like every other business in the United States.

Pre existing conditions like diabetes, asthma, lupus,etc will no longer cost us astronomical premiums that can increase whenever said insurance companies feel like it.

One thing that didn’t make go hmmm (it made go W.T.H) was why the FDA only had one person with the patient perspective speak at their hearings for meter accuracy. What’s with that?

Ellen Ullman was our voice at the hearing and she was WONDERFUL. Thank God she was there to speak on our behalf! And why shouldn't she have a place at the hearings? Aren’t the patients and their families the ones that actually USE THE METERS? Don’t the patients lives and well being depend on keeping track of their blood sugars?

Here's a question to the FDA: Why not include a multitude of patient perspectives in the hearings? It’s not rocket science FDA folk; it’s pure common sense. Talk to the people who use the product DAILY because their lives depend on it- not just the people who manufacture said product.

Click HERE to Send the FDA your patient perspective.

Click HERE to read an excellent post on the subject!

Another thing I understand but still don’t want to do is Basal Testing. The very thought of it makes say “OH SH*T” every time I think of what it entails.

I’m going to be honest here. I don’t want to fast and I don’t want to not drink coffee in the morning. I don’t want to fast, and I certainly don’t feel like getting up in the middle of the night to test and test again. Did I mention that I don’t want to fast?

BUT, and the but is KEY here folks- I want to be healthy and it’s been YEARS since I did basal testing - it needs to be done. My basal rates most certainly need to be tweaked, BIG TIME.

I’ll be starting my basal tests very soon and you'll hear all about it.

Another thing that makes me go hmmmm is drug/DME companies version of the “IDEAL DIABETIC.” We are far from perfect. We are not just the young and old, and our blood sugars vary from hour to hour. We are not all cute and fuzzy, and some pwds are more weathered and wise. Many look very much like the person you see in the mirror - Go figure? Companies need to represent us all- not just who YOU think we are.

Another thing that makes me cringe and go hmmmmmm is fashion. Seriously folks, who ever said that having a chronic illness must = bad, ugly fashion?

I don’t and won’t buy into that school of thought and neither do most of the PWDs I know. Stay tuned re: my passion for pretty diabetes fashion~

BIG Thanks go out to Amy, Mike, & Kerri for writing such excellent posts that I linked to in Part 1. THANKS GUYS~

PART 2

Why do people think Glen Beck speaks the truth? Just because he uses a blackboard doesn’t mean he’s a scholar or an authority on the “Real America.” Every single one of us, red state or blue, is part of the "Real America!" Just because I think Glen Beck is a moron makes me no less of an American.

And finally: Why are people obsessed with MTV’s THE JERSEY SHORE? I'm not even going to link to that piece of tripe!

I'm going to state as fact that those people don’t represent New Jersey as a whole. I grew up at the beach in South Jersey and that’s not how we were brought up.

Thats not how my friends and family bring up their children. New Jersey is the Rodney Dangerfield of states - Jersey gets no respect! And now with a show like that, we never will.

The people on that show are a horrible representation of the Garden State and give Jerseyites and Italian Americans alike a bad name!

What if the Queen Had Balls?

Tonight I fast...Fast for the battery of blood work that accompanies my Tri-monthly Hemoglobin A-1C.

Last night I fasted and was supposed to have blood taken this morning, but deadlines called, and tomorrow will have to do.
I don't know about you, but the anticipation of the fast; the test, the results, and what they mean, tends to do a bit of a head-trip on yours truly.

Will my numbers be good, or at least improved from last time?
Will medications have to be upped, lowered or added?

Am I on the continuing path towards health, or will my sister's words which paralyzed me years ago (see January posting) comeback once again to haunt me?

Tests freak me out, always have. Just go ask my High School Math teacher. Poor Mr. Mandell would watch as I'd start to tear-up during the test. I'd study so hard, my parents would pay good money they didn't have for a tutor, and I'd pass, at least the night before the test in the comfort of my living room, with my math tutor Joe, a former Big Band singer and WWII pilot with a great head for numbers. But during the actual test in school, I'd psych myself out, freeze up and forget everything.

Mr. Mandell would actually work in extra credit points that only I would know. For instance, on 1 exam the extra credit would be a point for every Woody Allen movie we could name. I got at least 10 extra points on that one. Another exam had us name previous Oscar winners and the films they won them for - that was at least 15 points thrown my way.

As an adult, I suffer from "White Coat" syndrome. They normally have to take my blood pressure several times because the 1st one is always high due to the fact that I know how important my numbers are.

It's really ironic, I can talk to large groups of people about living with diabetes and only suffer from butterflies and the wonderful adrenaline rush, but have Nurse Practitioner Chick take my blood pressure, and I have to talk myself down from a ledge of "What-ifs."

"What if my blood pressures high?"
"What if my urine tests have protein?"
"What if my blood work shows something that just should not be?"

Then I ask myself, "What if the Queen had balls Kelly, what then? Hmmm, good question.Well, then She'd be King or a really fabulous Drag Queen that’s what if….Get over the fear and get on with your life Kel!"

As Diabetics we live in fear of the dreaded "What Ifs,"on a daily basis.

I'm tired of the power that the "What Ifs " hold on me and I’m purging them from my life right now!
I'm going to focus on the fact that these tests are there to help and inform me, not hurt me.

I' m going to learn from them and live my life to the fullest.

Technology is our friend and knowledge is power.