LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014

My Photo
Name:
Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Monday, October 22, 2012

Return of the Death Panel


Sarah Palin was right. Wow. Never in my worst nightmares did I think I’d write those words. But she was. Death panels have been set up. But it’s not Grandma they’re after. It’s me. Me and my kind. Which is you. They’re after those of us with chronic illnesses. After all, we’re a bigger threat than Grandma. We’re young(er), sick and expensive, but technology—that double-edge sword—is poised to keep us alive (and expensive) for years and years and years to come.

And it’s not our government who wants us dead. It’s our health insurance companies. Circle the investors. Roll out the death panels. Wall Street must be protected at all costs.

Do you have any idea how hard I struggle to keep healthy? Well of course you do. You walk in my shoes every day and every night. I guess I addressed that to everyone who doesn’t have diabetes.

It takes an incredible amount of time, attention, concentration, effort, energy, and self-motivation to do this. And, like the rest of you, I still have multiple jobs, a wife and child, and an elderly mother and mother-in-law to care for. I’m worn out. I’m tired. In fact, most days I feel like Grandma.

So when I found a simple and effective tool that could help me make my life a little bit easier, remove just a hair of my daily burden, and make my diabetes control better, I rejoiced. A device, I might add, that was free for me and my health insurance company. A device whose supplies to keep it running cost no more than any comparable supplies.

Win/Win, right? Wrong. Read on.

Yes. Of course. It was a meter. And, yes, we are talking about test strips, all of which, frankly, cost about the same. And yes, I am talking about the new iBG Star, a meter that plugs into a device (iPod Touch) that I’m required to carry for work anyway. I mooched some sample strips to test drive it, and then liked it so much that I paid out of pocket for strips for a month until I could see my doctor. Liked it? OK. Understatement. I fell in love. Me, the meter whore, was finally ready to settle down and commit to a single device.

Why? I think it comes down mainly to reduced gear burden. It also helps that it’s very accurate. And that it shares a device with my insulin tracking system (the RapidCalc App). If you like it and its easy, you’ll use it, right? It sounds lame on paper, but the results are scientific proof. Because, unfuckingbelievably, I kicked my A1C out of the sevens and down to a solid 6.5, in control for the first time in years. The SD of my readings, the measure of how wild the ride is between my lowest lows and highest highs dropped like a boat anchor.

To top it all off, I felt better than I have in years. More energy. Better mood.

But like a man lost in the desert, teased by a mirage, it was yet another cruel joke of the universe.

Naturally, my doc prescribed the strips. And my health insurance said no. They won’t pay for the strips. Not even at a higher copay (which I would have been more than willing to pay). And to add insult to injury…. or perhaps injury to insult… the denial letter, no shit, started out with “Presbyterian exists to improve the health of the patients, members, and communities we serve.” And then it went on to say I was fucked.

They say they only pay for Roche strips. Nothing else. Period. End of sentence. End of paragraph. End of chapter. End of story. No exceptions. No upper-tier choices. It’s the Roche way or the highway (I smell a kick-back here).

But that’s not quite true. I know that there’s at least one exception: strips that talk to pumps. If you have a Med-T pump, they’ll cover Bayer strips for the meter that is part of the pump system. Likewise they’ll cover FreeStyle for OmniPoders and OneTouch strips for Animas pumpers. Why? Well, they are medically necessary as part of an integrated system.

So what’s the difference between that integration and the integration of the iBG Star? My iPod Touch has my insulin tracking, my carb data base, my timers and alarms, and my blood sugar data. You can’t get much more fucking integrated than that.

And not that I’m sulking, well yes I am, but this summer I choose to stop pumping and start using shots again for a lot of different reasons. That has saved fucking Presbyterian Health Insurance a boat load of money right there. Don’t you think strip-of-choice is a good quid-pro-quo?

I’m told, of course, that I may pay out of pocket. Let’s see, $1.30 per strip x 10 tests a day x 365 days in the year is $4,745.00. Is my good health worth five grand to me? That’s what Sarah Palin would probably ask. But her book sells better than my five books do. I don’t have five grand not dedicated to gas, power, light, and food.

But my doctor was so impressed with how much better I’ve been doing with the convenient-to-carry-and-use meter, that he offered to appeal the denial of coverage for me.

Let the games begin.

So in round one, he sent progress notes, lab results, and 12 pages of clinical data from my CGM, RapidCalc, and the iBG Star itself showing the before and after improvements. Hell, even I was impressed when I looked at the downloads. He had two arguments, first: What’s the difference between my patient’s integration and a pump system integration? And second: Are you people fucking crazy???! My patient is healthier. This saves you money. Not to mention it’s the right thing to do.



A week went by. Then two. Perhaps they were actually carefully reviewing the labs, downloads, and data painstakingly assembled and submitted by my doctor. Finally, I got a letter. Even though my doctor submitted the appeal to the denial of the prescription that he wrote, I had not signed the form. I had 10 days from the date of the letter to sign the form or the appeal would be automatically denied. Looking at the date on the letter, then looking at the cancelled stamp, I could see that the insurance company waited five days to send the letter. With transit time, I had 48 hours left. Nice. So this is how the game is played.

I signed and Faxed.

Then waited. And waited. And waited.

Then I got another letter. I had to sign a records release. Really? Give me a fucking break. An insurance company has a legal right to poke its nose into your medical records any fucking time they want.

And on it goes. One delay after another. Each time I have a tick-tock deadline, and each time they reset their clock to 30 businesses days. Clearly, they are hoping I’ll drop dead before they actually have to review the evidence.

I don’t think I’ll die. Well, of course I’ll die, but not soon enough to make my insurance company happy. Lucky for me we aren’t trying to get a cancer drug approved. Many people are complaining about the lack of technological innovation in tools for diabetes. But maybe we’re focused on the wrong thing. What good do tools do us if no one will help us pay for them? This is why we need insurance reform. Any of you out there who are happy with your health insurance have never used it.

But as to me, I’m out of test strip funds. I’m on my last vial of iBG Star strips. I’m bitter and angry. Angry about how much of my precious time and energy I’m wasting with this fight. Bitter that I devote every waking hour to helping fight the diabetes epidemic and I can’t even get the tools I need to stay in the fight.

The death panel wins.

Again.


5 Comments:

Blogger Sara said...

I wonder if stories like this will become more common as the health insurance changes of PPACA continue to take effect. More people have coverage, but maybe not the coverage we want?

Those Dexcom comparisons are quite impressive!

7:50 PM  
Blogger Jonah said...

My insurance company also likes Roche and lately I've been wondering why. They don't say they get any break from Roche- according to them, they're paying about $1.08 per strip, so you'd think they'd be happy if I wanted to switch to something cheaper. But no- in all of my insurance years diagnosed with diabetes (which is seven) they've had two companies on formulary- Roche and a rotating list of others (this year its Roche and Abbott). I figure either Roche is giving them some huge kickback that we're not seeing on our bills, or somebody has stock in both companies, or they have a formulary for nothing. I think there's probably a crime in their somewhere, and I mean a white collar prison sentence crime.
BTW, from what I've read the IBGstar doesn't have the accuracy the aviva does. See table four in this article: http://www.journalofdst.org/September2012/PDF/VOL-6-5-ORG2-FRECKMANN.pdf

6:25 AM  
Blogger Scott K. Johnson said...

Great post, Wil. As much as I hate these stupid battles, I very much enjoyed your storytelling.

8:49 AM  
Blogger david blickenstaff said...

That second Dexcom chart is enviable! What else have you changed to flatten out the peaks and valleys?

As for the strips, this is an old idea, but have you looked into ordering out of pocket from Candanian pharmacies?

2:05 PM  
Blogger Jetplanegirl said...

There is NO WAY it needs to cost this much to make strips and have a profit. And they do not have to be available only with prescription. My insurance doesn't cover strips at all-- it's all out of pocket for me. Testing is the only way I can control things... it's the only way anyone can.

4:14 AM  

Post a Comment

<< Home