Hi, all. I've never posted here before, but on some occasions when I've really needed to have my experiences validated, reading through this site has helped remind me that I'm not the only person in the world going through any of this. But now I'm crawling out of the woodwork, hoping for a slightly different kind of help...
I got a letter from my insurance company the other day saying that they are going to implement a "supply limit" for test strips effective January 1. They didn't even say in plain English what time period this random number of test strips would apply to. But if I'm reading correctly, it would come to about six test strips per day, whether I get a month's supply at a time or 90 days through the mail-order pharmacy. I have been testing more like ten times a day for several years, which my endocrinologist has somewhat grudgingly agreed to write prescriptions for, and I don't think I could swing paying the difference out of pocket.
Am I crazy to be testing this often? It's not like I'm asking them for extra vicodin (I wish!). A decade ago when I was diagnosed, I was told to test four times a day - is that still the party line? - but I'm at a point where I can usually figure out how to fix something that's off. I prefer to know what's happening before and a few hours after I eat, and test a few times as the night wears on to see if I'm stabilizing at a good place before bed.
My a1c has been around 7.0 for several years now - in the low 7s the last couple of times, but it's also been as low as the mid 6s several times before that. I know some would say that's not great, but it's better than when I tested less frequently. I can't imagine going back now. I'm a little ashamed to admit I've never bothered to research if my current insurance would cover CGM (truthfully I'm vain and I already have a love-hate relationship with having my insulin pump attached to me) and maybe that's a better solution, but it seems like the same principle.
Sorry...this has turned into a bit of a rant, and I'm sure plenty of people are rolling their eyes thinking, "You have insurance, what are you complaining about?" Bottom line, anyone have any advice? The letter did say that my doctor can request a "coverage review" if we feel that I need to test more than that. Has anyone had this kind of experience with their insurance company recently? If so, has your doctor had any luck with an appeal? A part of me is hoping this is just one more bureaucratic hurdle insurance companies have come up with to keep from paying for things and it's just a matter of my doctor writing to somebody, or is that wishful thinking? It seems like a doctor writing a prescription would be a strong enough endorsement for a particular dosage in the first place...
I actually just had to get a new 90-day prescription from my doctor days before I received this notice, which hopefully the insurance company will honor prior to the new year, which should buy me some time to sort this out - so I'm not panicking, yet.
Yes, do the coverage review. They want the cost justified, so having the review will provide them with the proof they need. I never had to take it to the level of 'coverage review' but my insurance company did try to limit my number of strips at one point. Call the insurance company and ask what the options are for you and how to proceed with a review.
A CGM wouldn't eliminate the need for test strips.
Call the insurance to make sure you understand it correctly. (You probably are.) But then you can complain about the policy to a person there.
If you think about it, it is 3x per day just to eat meals and 1x before bed, and if you are at least 16 and driving, you should test before you drive, so even if you skip the morning test because you test before and then jump in the car, you do need to test before you drive home from work. So there is 5. So heaven forbid you feel low during the day or want to have a snack, cuz, then there goes your 6 th strip. And if you ARE low and need to retest, now you've gone up to 7 strips for that day and will be short by the end of the month. (Because let's assume you actually have a life and drive some places on the weekend, so you'll need the driving strip for those days too.) You also have no extra strips for when you need to make insulin adjustments. Perhaps if you lay it out like that to the insurance person and their supervisor (and perhaps in a letter to them after your phone call) it will at least be brought to their attention that it is a ridiculous limit for someone with Type 1 D or any patient managing their diabetes with insulin.
I could see this possibly as a reasonable limit for someone with T2D who is managing with diet, exercise and maybe medications. But I think as soon as insulin is thrown in the mix, the chance for lows increases and then you need to test more - just to drive safely. COuld ask if they want to pay for your medical care if you get into a huge car accident because you ran out of test strips and went low while driving. I'd guess they'd rather not.
We test my son at least 8x per day. Your post actually reminded me that I had to call and request our scrip be increased to 10x per day because we were down to like 5 strips left in the house the day our 90d supply arrived in Nov.
Oh and all this would be in addition to the coverage review from your doctor. THat is what the insurance company will actually use to give you an exemption. Before that you are just being a squeaky wheel. :)
in my opinion, if the endo says it's medically necessary, and the insurance refuses it, you begin by filing an appeal. multiple appeals may be necessary, and you will need cooperation by your endo. You will also need a lot of time and the patients of a saint. The insureance co will give eventually, because going against the doctor's orders leaves them open to litigation. that's how many people got their pumps at first, that's how many many people got their cgms too.
I test 12 times per day, but my doctor has never approved of that many strips. He used to allow ony 6 per day, then a year later it was 8. Finally he approved of 10. To get the extra strips I needed, I bought a Relion meter for $9 at Walmart and a box of 100 strips for about $44. The Relion, in my opinion, is just as good as any other meter. The strips are only 44 cents each, and that is less than half the price of strips for name brand meters. It is a real bargain. When the Free Style strips sent to me by Liberty are gone, I use my Relion at my own expense, until my next shipment arrives.
Thank you, all. It looks like the 90-day prescription I sent in days before I got this notice is being processed as usual - fingers crossed - and I'm supposed to see my endo just before the new year, when the policy goes into place. So hopefully I can explain the situation to him and get the ball rolling, with a new order in hand to take me well into the new year.
And yes, the letter actually specified that the six-a-day limit applied to those who take insulin; there's an even lower limit for type 2 people who've never been prescribed insulin.
Also, good to know about cheaper options for getting test strips. I've seen the generic meters and strips before but didn't even think of that when I got the notice and looked up what the insurance supposedly paid for my last refill and immediately freaked out. I hope it doesn't come to that, but good to know for a backup plan.
Hey John I recently have had the same problem with my insurance. I was only allowed 200 for the month which is roughly 4x a day but I specifically told them I test more than that and my doctor faxed over 2 letters stating I test between and 8-10x a day and they still wouldnt put it through. Then I got pissed and said my old prescription was for 450 and the other company I had last month picked it up no problem and you guys are suppose to be better and then I was put on hold, asked a million questions, told them about my hypo unawareness, full time job, exercise 4x week and after a month of bulls*t with them I finally 300 out of them for the month. I just dont understand why test strips are so regulated. I mean I am not selling them to other diabetics on the black market, if you think so send the FBI lol. I mean they say checking your blood regulary can possibly help reduce complications so I would assume the insurance compnay would want you to test more so you can regulate everything better so you can stay out of doctors office, hospital etc.. it just seems bogus thats its so diffucult to get test strips, not medicine, just test strips!!!
Insurance companies sometimes suck. They had no idea and they make all these rules and judgement calls without any first hand knowledge. I just filled a 3 month set of prescriptions on all of Chasey's supplies and the pharmacy filled 800 stripes for us. That's about testing 8 times a day. The pharmacy just asked us how often we test and they figured out how many we need and they filled it. If our needs change I just let them know. We haven't been refunded for the expenses yet but I am sure our insurance won't give us a hard time. But they suck at other things. Like they wouldn't cover a CGM system or the supplies for it. Even though Chasey is only 6 and doesn't feel lows or verbalize them to us.
Starting Jan 1, not only did my Insurance Company limit the number of testing strips a day to 4, they also only changed the brand of strips and meter. They sent a coupon for a free meter. If I don't use their brand, I pay ot of pocket. I had similar concerns with only 4 strips a day because the doctor has approved testing 10 times a day. I'm so thankful for my doctor taking the time to work through an "exception' with my Insurance Company to allow the appropriate testing. My daughter just started driving so testing requirements have been increased for that reason alone. My question to the Insurance Company is 'What makes you think you know better than the doctor what treatments are best for my daughter"? You already tell me what doctor w need to see and then you refuse their treatment plan. Our system is so broken. Penny wise and Pound Foolish.
I had this problem too....I test about 10 times a day and my doctor had to write in a request to increase the amount of test strips I can order per month. My medical company said there's no reason I would need to test that many times in one day which is why I had to get my doctor to fax them the request. They approved me for 8 times per day, so I still barely have enough to make it through the month and always only have 1 or 2 test strips left when my next shipment finally comes. It's really frustrating, but that's the most they'll approve me for right now...I wish they would just let us order the amount that we need without having to do all these extra steps and STILL not have the right amount!
The saga continues...my doctor's office told me they called the insurance company weeks ago, I finally called the insurance co back after not hearing word one, and they claim to have no record of any correspondence from my dr's office! I don't actually believe them, but back to square one, and because the company does not have my dr's fax number in their records, the dr.'s office has to personally call them back again to give them the fax number where they can fax the form. The insurance company is not authorized to accept the fax number from me! I actually said, "I'm sorry, it's just my life and my body we're talking about here." At least this time I got them to say what the timeframe should be for a decision after they do receive a response from my doctor, so next time I can call them right away to make sure my dr.'s form hasn't disappeared again (when I asked "can I call you back and find out if the paperwork has been received?" the rocket scientist to whom I was speaking actually responded, "Well you won't necessarily speak to me personally, but one of our representatives, yes").
Meanwhile, I received a letter saying that payment for bloodwork done by that same dr. was on hold, pending a survey I have to fill out regarding whether or not the injuries being treated were sustained as the result of an accident which may be covered by other insurance. So, I called the number that they gave, and was somewhat puzzled when they started asking me questions about my broken collarbone. I had to explain that I did not break my collarbone, that I have never broken my collarbone, and that if went to to doctor because I had broken my collarbone, I don't think an a1c test, et al would be very helpful.
I can't help but wonder if they did receive the appeal letter from my doctor, and subsequently "lost it," and then drummed up this collarbone investigation to delay payment in retaliation for my dr. challenging their new policy? Ugh, I want to move to Canada.
John-I'm so sorry about all this you're dealing with! I know it's such a headache.....my doctor and medical supply company seem to often "misplace" or "never receive" documents either. It's not fair to have to deal with all this paperwork and try to be the liason between the dr and insurance company, on top of dealing with the daily struggles of diabetes!!
I really hope this all gets worked out for you very soon!!!
Vicki, I had that problem too. My insurance company told me that the One Touch was their "preferred" meter and test strip so I would have to pay roughly double to get the Freestyle, which is what I MUST use because of the meter that is built in with my pump. The only thing is they never told me they just started charging me the higher amount. When I called to find out why, that's when they informed me that I was using the wrong strip. I explained that my pump requires me to use the Freestyle, but they basically said "too bad, our preferred is One Touch". The attitude I got was "get over it" or change. And this is Aetna! So now I pay the double amount.
They also decided on their own that my doctor was prescribing too many strips and started sending me the amount they thought was appropriate without checking with me or the doctor. I just started receiving fewer and again had to call and ask why.
They are just unbelievable. Obviously they don't have anyone in their family with a chronic illness. They are just so flip about it. Makes me angry!
John-I'm so sorry about all this you're dealing with! I know it's such a headache.....my doctor and medical supply company seem to often "misplace" or "never receive" documents either. It's not fair to have to deal with all this paperwork and try to be the liason between the dr and insurance company, on top of dealing with the daily struggles of diabetes!!
I really hope this all gets worked out for you very soon!!!
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Thanks, Sarah. It sounds like you definitely can relate. I hope you have better luck with your insurance company in the future...it is very frustrating, :(
I have been venting about this lately. We haven't run into the insurance issue yet because I haven't tried to get more. Right now Jonas gets 300 a month, but I'm finding that there is no way that's enough. I can't imagine only getting 250! How are we supposed to make sure they have great numbers if we have to be stingy with our testing? At a minimum we use 6 strips a day. That's one for each meal, Lantus time and then two snacks. We have 110 strips left to last us until Feb 11th. We have used the other 190 since the 12th. When there is a low reading, we need to check again. Then we may have to check all night. I swear we were using 12 a day last week when he was sick. I'm going to be asking to be upped to 400 a month or at least 350 but I just don't understand why they fight about this. It's not like it's a drug. It's drawing blood! So ridiculous...
Thank you, all, for your advice and listening to my venting. After starting the whole process once again when the insurance company claimed to have no record of the form having been received from my doctor, his office finally completed a new form and submitted it, again, and the insurance company finally approved me for 10 test strips per day. (At least, for the next year, but presumably I can get reauthorized a year from now...it's already on my calendar to start the ball rolling way in advance.)
Thank you, all, for your advice and listening to my venting. After starting the whole process once again when the insurance company claimed to have no record of the form having been received from my doctor, his office finally completed a new form and submitted it, again, and the insurance company finally approved me for 10 test strips per day. (At least, for the next year, but presumably I can get reauthorized a year from now...it's already on my calendar to start the ball rolling way in advance.)
Hey, John. 10 times is excessive, but if it works for you, I would fight it. I had to test up to 10 times her day when I was applying for an insulin pump.
Coverage reviews should be available through your insurance- your endo's nurse would just have to call and submit your information (called a prior-authorization) proving that you need to test that many times per day (i,e, hypo unawareness, hyperglycemia).
So it could be a process - when I needed a prior authorization for my 10 test strips per day, it took a good 30 days before it was approved.
But everyone's insurance is different, so hopefully you get this figured out.