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, 2015, 2016

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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!).

Thursday, June 09, 2011

Good morning Mr. Dubois, we’re calling to tell you that you’re screwed

There oughta be a fucking law… well, come to think about it, there oughta be a lot of fucking laws. So today, Edgepark, the durable medical goods outfit who is the preferred provider for my Presbyterian health plan called me.

It turns out that my plan stopped covering one of my common insulin pump supplies.

A year ago.

Pres didn’t tell me.

Pres apparently didn’t tell Edgepark.

Edgepark apparently didn’t pay attention to the fact they weren’t getting paid for a year.

And now guess who gets stuck with the bill?

Yes. That would be me. The guy who can’t even afford to buy a full tank of gas for his Jeep in this economy. Oh well. What’s one more bill between friends? It’s not like I was planning to retire. Ever.

But what really makes me mad.. well, madder… is the whole process. The lady from Edgepark tells me that the official line from the insurance company is that “verification of benefits is not a guarantee of payment.”

Excuse me?

Ummm… now wait a minute. I’m stretching my infusion sets to four days ‘cause I know with 100% certainty that my quarterly shipment of keep-me-alive supplies will be held up for weeks while everything from my blood type to my doctor’s great-grandmother’s maiden name is confirmed, double checked, re-verified, and approved.

And all these delays and bullshit and stress and frustration are for… nothing?

I could just scream. In fact. I think I will.

Excuse me while I step outside for a moment.

Well, now I feel better.

No. Wait a minute.

I don’t.


Blogger Scott S said...

I would dare say that you, Mr. Dubois, have a compelling case to bring to Small Claims Court because the parties trying to collect from you failed to communicate these not-so-little policy changes. The reality is that most companies can't be bothered to send anyone to Small Claims Courts in jurisdictions around the country, and if they fail to show up, the Judge will typically rule in your favor. Just check the policy to determine if there's a mediation clause in it, if there is, you may have to use a neutral third-party arbitration association (at your expense, but its most certainly less than the amount they're trying to collect). Good luck!!

7:28 PM  
Blogger Unknown said...

UGH. Sorry Will, that SUCKS.

7:52 PM  
Blogger Jonah said...

I think Scott's right about Small Claims Court likely ruling in your favor- this is pretty wrong headed- but I think that first you should call both Edgepark and your health plan and try to convince them to reimburse you.

Because I know a guy (a teacher in my high school who taught a class about law) who won a case in small claims court. He brought a case against a mattress store because the store didn't deliver the mattress he'd paid for. But the court said it couldn't make the mattress store reimburse him unless it had the mattress store's bank number to freeze.

9:10 PM  
Anonymous Anonymous said...

This sucks, and I'm sorry Wil. I'd go the route both Scott and Jonah mention.. but would start with the writings to Edgepark and health insurance folk. Sometimes, you can appeal to someone there - even if it's a supervisor. If that doesn't work and they don't agree, there's always the state insurance commissioner. I've only had to go that route once, but my mom has done it a few times up in Michigan and got rulings in her favor twice. In my case, they disagreed but ended up paying just to shut me up and make me go away. Anyhow, good luck. Sorry the frustration is forcing this move to begin with.

1:20 PM  
Blogger Scott K. Johnson said...

I love this stuff. You know, living with diabetes isn't hard enough. Let's go through extra crap like this to make life interesting.

I'd love for you to somehow keep track of time spent and mental anguish dealing with this.

2:33 PM  
Anonymous Casabby said...

Something seems awfully wrong that they can say that insurance will pay for something, deliver it to you, and then try to hold you responsible. I certainly have no advice for you, but will keep my fingers crossed that something can be worked out.

7:35 PM  

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