Your insurance cares about you--Act 2
Deb answered then held the phone out to me. For you.
Juggling three pumpkins, I took the phone, which then made a strangled squawk to tell me the battery was low.
It’s Lujan from Pres. She a clinical nurse something or ‘nother
“ Hi, William, I’m just calling to follow up on an email we received from Life Masers. Apparently you don’t want to participate in our new diabetes program because you feel that we should be spending the money on providing adequate numbers of test strips instead?”
Yeah, that’s right. I’m sure your records show I’m a type one on multiple insulins. I should be testing ten times a day.
“I couldn’t agree more,” said Lujan.
I dropped the phone.
After setting down the pumpkins, picking the phone up, and plugging in to a charging cord, Lujan and I had a pleasant conversation.
Turns out Pres will allow up to 300 test strips per month for T-1s. Catch is you pay a co-pay for each box. That said, so long as you use their preferred type (AccuChek Aviva) they’ll give ‘em to you at $10 per box; which is really a pretty good deal. Of course, you have to get all 300 at once so you need to cough up thirty clams at the pharmacy. (Being a weeeeeee bit behind on my pharmacy tab I’ve been demoted to pay-as-you-go. OK, so maybe 690 bucks isn’t a weeeeeee bit.)
If I was still able to use my CoZmo pump they’d actually pay for FreeStyle strips. Wish someone had told me that back when I was still using my pump. You need a prior-auth, but it is always approved. Sigh. Why does insurance have to be so complicated?
She was sorry to hear I’d been caught in a plan with poor Durable Medical Equipment (DME) coverage. Apparently there are “thousands” of different Pres plans. Some treat D-folk better than others. “It’s a nightmare,” she tells me. More support for my fundamental belief that good insurance is really only offered to those that will never use it.
I didn’t think to ask her the question every pumper in the world wants an answer to: why the fuck are infusion sets considered durable medical equipment? There it nothing durable about them at all. Ya’ throw ‘em out every three days. Or four. Or five. Depends how poor you are and how much you are willing to risk an infection.
Back to teststrips. Lujan told me that teststrips are the sinlge largest expense for Pres of all medications. She also said they have been giving D-Folk more strips and tracking A1Cs to see if they improve with greater testing. Her official line is that Pres is willing to pay more up-front to save money on complications later; but at the same time the British study indicating that testing may be a waste of time is casting a long shadow. I feel a collective shiver across the diabetes landscape as that cold wind continues to blow down from Brittan.
She also tried to get me to switch from Humalog to Novolog; a change of $55 per box to $35 per box of five. Yeah, I used Novolog for years, but it isn’t doing the job anymore. The Humalog is. OK, well, nothing you can do about that.
She also told me that for some seniors caught in the “gap” of their Part-D coverage, many providers are having their Lantus/Levemir users go to Wal-Mart and buy ReliOn NPH out of pocket. This does not require an Rx. Feedback Lujan gets is that the old-school NPH is doing the trick for a lot of folks. Hmmmmmmmmmm….. I’m suspicious of that.
I’ve used NPH in the past. It’s a little… unpredictable. It also has a waaaaaaaaaay shorter duration of action than the two “L”s. Still, something to keep in the Break Glass in case of Emergency box. I snooped around online and found press releases stating that ReliOn brand is made for Wal-Mart by Novo. In fact, all three Novolin insulins (regular, NPH, and a 70/30 mix) are at your friendly neighborhood Wal-Mart for the alleged price of $16.94 per vial. Wal-Mart reminds us that they have ReliOn syringes and glucose tablets too.
I was really impressed with Lujan. Not what you expect from an insurance nurse at all. I wondered if she was one of us.
Can I ask you a personal question?
Long silence, then, “Sure.”
Are you a diabetic?
“No, I’m not, why?”
Well you’re doing such a great job for us, I figured you must be one of us. I’ll tell you what, I’ll make you an honorary diabetic.
Laughing, “I’m honored…. I think. At least I’ll have something to tell my family when I get home tonight.”
Congratulations, you’re now a member of the tribe. We’ll get you your T-shirt and Glucometer later.