We switched health insurance providers again a few months ago, because of a new position my husband took on. I braced myself for the fallout. Despite the fact that I got an early start on informing our various physicians and pharmacies that we’d be switching, it’s once again been an extremely bumpy road — er, more of ridiculous time-suck, if you want to get particular about it.
1) Various doctor’s offices insisted that were “still covered” under the old insurance up to a 
month after our new insurance kicked in (nervous about reimbursement, I presume, they wouldn’t take my word for it that our status had changed — not without the slow-coming paperwork from Insurance du Jour). This meant that about 3 pediatrician visits, 2 eye exams, and several lab tests for me were erroneously billed to the old insurance. I am still faxing and phoning on a daily basis to clear up that mess.
2) Wellpoint mail order pharmacy (I don’t mind mentioning them by name here) has the stupidest online customer interface I’ve ever seen. I tried to bookmark the page, but you get consistently redirected to a login at the main Blue Cross coverage site, and then are forced to click through no less than 5 additional confusing screens until you actually reach the NextRx page. Ugh. Don’t they know how often a diabetic like me has to go through that labyrinth?
3) The mail order pharmacy somehow did not receive my (long) list of prescriptions the first seven times my doctor’s office tried to phone/fax them in. This means I had to hound my Dr’s office manager with dozens of calls and emails to ask her to resubmit. Poor Gal. And no wonder these people are so overwhelmed with process details.
4) When the mail order company finally did get my list, they started filling everything right away, despite the notes stating that most of the Scripts were to go on file until I was ready to order refills. Upshot: $45 in unwanted co-pays, and another 2.5 hours in phone calls to get fees waived for the rest of their mistakes.
5) The Test Strip Ordeal. Happens every time. First the new insurance insists it’s “too soon to refill.” Then I go through all the trouble of having my doctor submit a Pre-Authorization form stating that I need the darn things. Then they finally send me some, but not enough.
This time, when I realized that my first pack ran out way too quickly, I insisted on speaking to a pharmacy supervisor on the phone first thing. I was told that my prescription specified testing glucose only 5-6 times a day. Wtf? My doctor knows me better than that. After verifying with my doctor’s assistant that they’d indeed wrote a Script for testing 10-12/day, I spent some more time on the phone with a different mail order supervisor-lady. This one revealed that the problem lay with my insurance coverage, which was putting a cap on my daily allotment of test strips, apparently. Wtf?
Excuse my language, but I had to get pretty heated on the phone to get the insurer to actually contact the mail order house and OK the test strips that I needed last week, thank you very much! And you’d better send them via rush delivery, too! Or do you prefer to foot the bill for a visit to ER?!
OK, rant over.
Hey PWDs: Does this stuff not just infuriate you? Sometimes I think it’s the hardest part of having a chronic illness.
Hey Healthy Folks: Aren’t you glad you don’t rely on your medical insurer for the essentials of your everyday life?
It does infuriate me. We spend more of our time managing insurance and doctors than we do managing our diabetes
I was told awhile back that PWD have a “short fuse”—ie. get angry quickly! We have all been through some sort of medical/insurance mixup just as you described, Amy. Is it really any wonder that PWD get angry!!??
Sorry about all the mixups—-hang in there!
I go thru this all the time…I have not switched isnurance in over 4 years. Gotta love the Healthcare industry.
It really is awful! I’ve switched a lot in the last 3 years and its almost like a 2nd job. When I was in social work, I remember helping people navigate the housing/food stamp/Medicare labyrinth and that was also the de facto *job* of a homeless, mentally ill person. Something has got to change.
The strip thing is a constant mess. Lately the doc has come to the conclusion that T2s don’t need to test more than twice a day unless they’re on insulin. WTF? I test an average of 5x/day and I know I should be testing more frequently than that. We really do need to know what and when to eat, and some of that is dependent on bg readings. Plus there are all those incidental readings b/c one doesn’t feel right, one isn’t coming down from a meal correctly (or one is coming down too quickly), and so on.
I find it ironic that this is exactly the kind of bureaucratic nightmare that libertarians warn me about when they talk about universal health care. I have been diabetic for twenty years, and have NEVER encountered a private insurer that didn’t put me through a maze similar to the one you described here.
I’ll take the DMV over AvMed any day of the week.
Someone? informed Medicare that they were no longer primary for us. All of our part A claims rejected and cannot be resubmitted for fifteen days from when we finally cleared it up.
What I cannot figure out is how ‘really olde’ people work through this mess.
Most of our problems are because we choose to stay with Fed BCBS instead of Medicare B. Medical billing apparently still required by medicare even though we don’t have the coverage???????????? Washington are you listening?
I think I smell a place where you could save some money.
Dealing with insurance was one of the nasty eye-openers after my diagnosis. Fortunately I’ve only had one change of insurance since then. One advantage of single payer healthcare would be one learning curve for all of this and never having to re-establish coverage with a new company.
I also have to re-navigate to the NextRx webpage everytime. I’ve tried and never been able to synchronize the various scrips so I can refill them at the same time. Each has its own timing (and copay, of course, even the lancets). Yep, being a good little diabetic, I once tried to order 9 test strips daily and was denied via letter. Nothing makes it clearer that health insurance is geared toward profit. Once or twice a year, they send me glossy pamphlets about taking care of diabetes (generally T2 oriented) and I just roll my eyes. I also roll my eyes at needing a doctor’s scrip for my supplies. I suppose the syringes have to be regulated but why can’t my status as a diabetic be somehow permanently noted in the medical records of my pharmacy so I can refill without doctor scrips? It’s not like my diabetes is going away!
This again makes me give thanks to Group Heath Cooperative. While we run into roadblocks at times at least we talk to a real person – who listens!
Yes, some requests have to go through a committee – mainly for referrals out of the system – but if my doctor makes a special request, like for more test strips, the request is put through. And all my records are in one spot and all my docs talk to each other and everything is accessible through GHC’s wonderful electronic system! I can check my records, check results of past appointments, check on upcoming appointments at any time of day or night. This is the way all health care insurance should be!
I am blessed to have insurance coverage. I cannot imagine life without it. However, that coverage comes through my wife’s employer. This employer is a international corporation that renegotiates their health coverage with a new provider every year. Yes, every year.
So every January every thing changes. I have been lucky to keep the same physicians, but the prescriptions and co-pay changes are a mess for the first 3 months of each year. And then this past January we where greeted with a surprise. The coverage we selected, which appeared nearly identical to our previous coverage had a sneaky “premium prescription” checkbox that we missed in the application.
Missing this checkbox double the co-pay on most of our prescriptions, even generics, so our household budget has gone into trauma mode. Excellent news in the midst of a recession when I still cannot find work.
Still, I am blessed to have coverage.
Every time I reorder strips I get questioned on why I am ordering so soon. And I can’t use the online forms because I am always refilling too soon. They will fill it if I explain. It sure would be nice not to have to do that, though, FOR THE REST OF MY LIFE.
Your post could have been written by me, change the identities of the companies involved. I don’t know why they don’t get the idea that I have Type 1 diabetes and it will never go away…if it does, they will be the first to know!!
This is why I keep considering the idea of getting a medical tatoo on my chest stating the same….with the instructions to “give insulin.”
While the “healthcare” system is for-profit, patients and doctors will be screwed in every way possible. If the insurance company can make a few extra billion hassling sick people and denying them care, what’s to stop them from doing so? Certainly not human decency or any laws I’m aware of. It will make their balance sheet healthier while people get sicker. It is BEYOND immoral.
And we should demand change, name and shame these companies in every way possible. I have no problem writing that Anthem Blue Cross of California does not cover my test strips, nor do they understand that “type 1 diabetes” doesn’t “improve with lifestyle.” I could run a marathon a week and I still wouldn’t make insulin. I have filed complaints with the CA insurance commissioner’s office, half a dozen times now. Dealing with insurance company nightmares is not just another fact of life or reality of being sick — it is abuse of human beings in the name of profit and the systematic de-valuing of human life. Appalling.
Wow, it looks like we’re truly not alone in our misery. I’m now going through a new change in insurance since our company was recently bought out (by a healthcare company of all things). It’s always a nightmare, can I keep my Doctor, can I get my supplies (on-time? enough of them?) etc.
I’ve been through the “3 tests a day” strip limit placed on me by an insurance company (whadda ya mean you crashed your car because your bloodsugar was low?? You should test more often, you must be an out-of-control diabetic!!).
Luckily, for now at least, I’m getting enough insulin and test-strips. Previously, I’d fill my insurance share with the most expensive test strips, and then buy enough of the store-brand strips (and $8.00 meter) to be able to test enough.
I’ve had plan-authorized-doctors refuse to renew my insulin prescription until I came in and saw them! (Really, Type-1s need insulin to live??)
No wonder everyone is saying that we need healthcare reform, I just hope it’s not a “be careful what you wish for” scenario. It shouldn’t be bad though, because if the Government can successfully regulate Wall Street and the Banking industry like they have for the past decade, why not Heathcare?
I keep telling everyone that Obama will make things easier for all of us. My friend who works with the President tells me that he is deeply interested in Diabetes and thinks everything should be free for us. Yay. I’m so glad I voted for him. Yes!!!
As a (former) health care researcher, type I for 30 years, and pump wearer for 24 years, I have been put through the wringer too many times to count. All I can say is to keep fighting, kick it up the insurance company ladder, and ask for intervention from your insurer if you work for a commercial concern or your insurance rep if you don’t. The insurers policies are meant to save them $$$ not help you. If they can save money by using uninformed and – well, stupid – customer service reps they will. The insurers totally save money on denial of care. How many people will fight for months the way we do? Keep up the fight!!!
It does make me mad. But what makes me even madder is how hard it is for D friends of mine without health insurance who are paying for this stuff on their own.
The last time I refilled syringes, they came through totally covered instead of 80%. I was curious so I called and asked why and they said it had been submitted as “medical supplies” instead of as a prescription and our medical supplies are covered at 100%. So I dug a little deeper and got the name of a local “medical supplier” (which is also a pharmacy) and discovered that all our medical supplies can be covered at 100%, and that covers the test strips also!! I was shocked! Why didn’t I know this? We already have good coverage and I thought that paying $260/yr for mail order strips was a pretty good deal. Now we are getting them free, along with the syringes, needles, lancets, etc. I am amazed and happy, but also a tiny bit perturbed that I didn’t know this before, especially since I think I do a pretty good job at keeping myself informed about our insurance coverage. Why didn’t I read this somewhere? Why did I have to discover it through a “mistake”?
1. I am a self-payer (un-insured), Type I diabetic for 35 years.
2. Still, I am amazed at the info about ‘medical supplies’. Why doen’t we know that after all these years.
3. People should know about the brand, “ReliOn” Blood Glucose Test Strips. Cost: $21 for 50 strips at Walmart. That’s right. Less than $.50/strip.
4. People should know that insurance companies by nature;
a) try very diligently to NOT pay claims. Expect it.
b) Insurance Companies are one of the top three profitable industries.
c) They are, in fact, just another cog in the wheel of efficient health care, sopping up money that could be going to lower health care costs.
5. Which all points to the advantages of a Single Payer system.
I wonder, since I have been having this problem only recently, what the deal is with insulin.
It says to throw it out 28 days after first using it. My insurance will not cover a refill until 30 days after it was last filled. On the insurance website it says that I should be paying $25 for ten units, and the pharmacy says the insurance tells them to bill me $50 per 10 units.
I’m so confused by this, that I am forced to go to mail order, even though I don’t have a credit card or a checking account.
I also love that my insurance pay such strange amounts for my appointments, that I get bills for 60 cents and $1.32. Strangest thing.