Our insurance company changed on June 1. The small business that my wife works for switched to United Healthcare, which was only raising rates 14% rather than the 40% hike predicted by Wellpoint Anthem.
In many ways the coverage was similiar to what I've seen in the past, but this new policy brought a new element I'd never experienced before: Blood Test Strip Supply Limits.
The formulary booklet lists all three tiers of test strips, and magically the One Touch Ultra test strips that I use fall into that first category. Lucky me. Of course, there was a fun little code of "SL" in bold behind the brand name. The key at the bottom revealed this to mean, "Supply Limit." It almost brought a smile to my face, as I'd never lived with this type of limit before but had heard the stories from those who have. There's probably no way to avoid a fight on this one, I thought, so bring it on!
In calling UHC on Tuesday to discuss my policy coverage and what this means for my daily D-Management, I spoke with a very nice Helpful Customer Service Girl who answered all of my questions. Sure, the answers weren't all what I would have preferred. But she answered them, and I appreciated that.
She checked her system about my particular brand of BG Test Strip, and informed me that my coverage allowed 102 test strips a month. That smile returned to my face, and I chucked as she went on about something or another that really wasn't relevant to the conversation. Is that what you use, she asked?
Me: "Um, no. I am a Type 1 diabetic, which means I use significantly more than that."
Her: "Oh. How many do you use?"
Me: "I test anywhere from 8 to 10 times a day."
Her: "Oh... Is there a reason you test so many times a day?"
Me: "Yes, there is. I'd like to live past 35 and not lose a leg."
Her: "Well, if you use more than that 102 a month, your doctor can request an exception for a higher amount. If that's approved, then you would be able to receive those for the same co-pay."
Co-pay for a month's supply is $10. A three-month supply is $25. That includes mail-order supplier.
Me: "So, my doctor needs to get special approval for the amount of BG strips she thinks is necessary to keep me alive. Ok. But even that requires United Healthcare's approval?"
Her: "Yes, it does."
Me: "What happens if that isn't approved?"
Her: "You can appeal. There is a process in place."
Me: "I see. Ok. Thanks. I understand."
The nice girl answered my questions, and though I wasn't fond of the answers, she provided them kindly and without multiple version of the same story - as is a common happening when talking to health insurance people. I appreciate that. Yet, she just didn't understand why it was necessary for me to be able to test more than three times a day (actually, 3.4 times a day if my math proves correct). Honestly, I don't know what I would do if that amount of daily BG tests was all that was allowed. Any notion of good D-Management would be out the window.
An over-arching message, again, is that is that health insurance companies don't listen to what doctors order and instead want to rely on their own blanket-formulas to limit their own expenses rather than provide what's needed for adequate health care. I get that insurance companies have a bottom line. They want to make sure policy-holders are actually obtaining what they will actually need and use, because test strips are very expensive and way too costly. But too often, these companies fail to recognize a basic reality: that People With Diabetes generally will use more test strips than what might have been otherwise ordered. With BG Meters being notoriously inaccurate by 20% or so, you might get an inadequate blood message or another error that means using another strip. Or you might have to test more than once at any given time to make sure the insulin you're giving yourself won't take you too Low and lead to bad things. In the event of a Low, you have to test MULTIPLE times to ensure that you're back to safe levels.
You know, the practical considerations of BG Testing for People With Diabetes.
So, we do what we must to battle the insurance and financial woes necessary to obtain these needed supplies. Those us with insurance have it well, compared to those who don't and have to dole out the insane amounts for few strips. I'd just endured a hellish process with my previous insurer and mail-order supply company to receive a covered 3-month supply of strips. You may remember my rants about that - here and here. This exact discussion and Supply Limit issue is exactly why I made sure to order those strips early through the former insurer, to make sure that I had enough on hand in case there was some crazy delay or limitation. Looks like my thinking was pretty much on cue, after all.
So, in the next week, I'll contact my Endo's Office to fill her in on this new prescription hurdle and have her do what's necessary. There is hope that I won't have to appeal and United Healthcare will see the logic in providing what my doctor has deemed medically necessary for my D-Care. Yet, confidence in that result is not as strong. It's a hope that lingers, like the hope for a Cure. But it doesn't change the fact that we must Live With Diabetes in the meantime, and use the process that's in place - for better or worse.
This does make me wonder, though... Would the insurance industry be willing to do what some in the Pharma have done: listening to the Diabetes Community about their concerns, likes, and dislikes? Roche has reached out to the Diabetes Online Community and Minimed has done the same in Europe. But what about Wellpoint Anthem, or Blue Cross, or Cigna, or Aetna? Would those players be willing to listen to those who feed their bottom line? Is this worth advocating for, or would it just be a waste of time? We'll see what the future holds on this one.