No Feet…

Shoe TreeWe are lucky, you and I.

Whether you are a Type 1 or a Type 2 diabetic or any part of the diabetes community, remember we have come a long way since Banting and Best (and the doggies…thank you to the doggies). We have drugs that keep us alive and kicking along with technology that gets slicker every year. Yes, I kvetch and kvell about how expensive it all is, but when it comes right down to it, I’m so very grateful that we can afford insulin. I love my life and look forward to a long one. (Yes, one without diabetes would be better, but, well, you know…)

You’ve heard that little ditty about: “I complained that I had no shoes until I met a man who had no feet.” Well, I met a woman who had no feet. (She had feet, but you know where I’m going, right?)

I’m currently dissecting our new insurance plan that comes with John’s new job in another state where he is and I am not. (Must. Remember. To. Breathe. Occasionally.) The questions I had regarding coverage of my insulin pump and continuous monitoring supplies had me calling the HR department, where I spoke with a very nice lady who gave me all the info I needed…and more.

We were commiserating about the obvious lack of detail in the documentation that insurance companies give you and how everything these days requires calling them to check on what’s covered. She gave me some great news about my prescription coverage and I shared with her that my old coverage had me essentially paying out of pocket for bottles of insulin and strips until it finally kicked in. She was shocked… and then she shocked me.

“I’m currently in a protracted argument with the insurance company over one of my prescriptions. My doctor said it was approved, but they’re now telling me it’s not. It costs $17,000 every three weeks and they’re denying it.”

Never met this woman, but I can say with certainty that this prescription is not for cosmetic or non-essential reasons. She needs it (or her doctor says that she needs it) and whoa… what do you do? I asked her and her simple reply?

“I keep fighting.”

Life is not a contest of who has it better or worse. I am full of “first world problems” as we like to joke around the house, but as much as I complain about my lack of shoes in the diabetes/insurance sense, I am forever cognizant of those who have no feet.

I don’t know what the solution is (and thank the universe that I don’t have to figure it all out), but there has to be a better way to give those who need lifesaving medication to get the access they need without bankrupting them. (And those who don’t have access to insulin at all? There are organizations to give insulin to those in third world countries, but there are a lot of cracks in the U.S. medical system, too.)

What I do know is this: When you meet someone who has no feet, you help them in any way you can, even if you have no shoes.

That’s why I advocate.

 

Dinosaurs and Good Health Care Insurance…

What do dinosaurs and good health care insurance have in common?

Both are extinct.

DinosaurAt least in my world. I am longing for the days of my youth, when my parents’ health coverage was super-duper. It was like living on Big Rock Candy Mountain, except it was insulin that flowed freely and test strips that grew on trees. I had numerous in-patient  visits to Joslin Clinic and not once did we worry about insurance issues. (Except when a study was supposed to cover labs that were in addition to my normal labs and kept billing insurance for them. That’s a funny story for another time. Promise I’ll get back to that.)

Good-bye Candy Mountain. When I began work after university, I learned about “pre-existing conditions” exclusionary policies and dealt with purchasing insulin and supplies out of my own pocket (and sometimes getting an extra vial from my doctor). Please forgive me for waxing nostalgic, but I remember when I could buy a vial for $30. I wasn’t testing quite as frequently, but I was getting by, waiting for the one year “no diabetes coverage because it was pre-existing” to be up.

I got up close and personal with the ugly side of exclusionary policies when, at 23, I developed pancreatitis and was hospitalized for six days. The ER doctor had written in the intake notes that my blood sugar was elevated and I had ketones in my urine upon arrival, and the insurance company denied coverage due to “DKA”.  It took me making phone calls from the hospital bed and getting records changed to show that I was admitted to the ER and hospital for pancreatitis and nothing to do with my diabetes.  I would have ended up with an almost $40,000 bill otherwise.

Over the years, I’ve had some good health care insurance plans and some not so good, but now… I’m staring into the abyss of the high care deductible insurance plans that are all the rage these days. I’ve talked about how expensive it is to take care of diabetes, but as John will be changing jobs soon, I’m grimly steeling my jaw at the upcoming changes.

High-deductible health care plans are great if you are healthy. They suck if you have a chronic illness. They’re actually classified as “catastrophic illness” plans and feel like such. More and more companies in the U.S. are choosing to go to these plans, because… they’re cheap. If you’re going to offer a health care option for your employees (soon to be mandatory in 2014 for U.S. companies), this is what everyone says is the cheapest way to do it. You pay a premium, you pay everything until you meet a ridiculous deductible, and then coverage kicks in.

We did it last year. Choices were made that I never thought I would have to do when it came to my health. Priorities were made. Prescriptions have to be paid up front and I need insulin and strips, so no delaying those purchases. Alas, my CGM sensors were shoved at the bottom and not purchased until the crazy stupid deductible was met with a string of surgeries that couldn’t be put off. The same is happening now. I’m not paying $60 for two vials of insulin. I’m paying $296. Don’t get me started on the rest of my supplies.

(I understand why some supplies are expensive. They have to cover the cost of research. But I have an issue when I am told that with an insurance discount (and I know that my insurance does not pay for any of it, thank you very much, so there is no discount…), a particular supply is around $300, but without insurance, it’s $795 according to the packing slip. Who is going to pay that? Not me. Probably not you.)

John’s new job has a “traditional” health plan option that doesn’t require a deductible for prescriptions. I’m sure that there are caps and limits and denials coming ahead. I also wonder when they’ll drop that and only offer high deductible plans. We don’t have an extra $1096 a month to shell out for 7 months before insurance steps up to the plate to pay part of my prescriptions and medical supplies. I’m so angry I could roar like a T-Rex.

Poor dinosaurs. I am starting to understand how they felt.

How do other diabetics deal with high deductible insurance plans? I’d love to hear from other Type 1s who have these…