Insurance ramblings

We live in a small town and our pharmacist is approximately three blocks away. Lou isn’t a franchise, he’s a small store with a huge heart that takes care of my family when a need for medication arises.

When you have diabetes that need is a constant. While I was thrilled to have Hannah start pumping, I was saddened to have to order pump supplies from Animas. I was truly hoping that Lou could handle that for us. I want to give him business, it’s not easy trying to keep a business afloat in the best of times, let alone in this economy.

Now, to make matters worse, with some recent insurance changes I am forced to use a mail order company for our test strips. This past month I called Lou for our standard order and to give him my new insurance number for Priority Health only to find out that Hannah is restricted to 200 test strips a month regardless of Doctors orders.

Let’s do the math on that one. Using a 30 day month, that is allowing Hannah 6.6 times per day to test.

2am check, breakfast, lunch, snack, dinner, bedtime. Six times at the barest minimum.

No allowances for highs or lows. No taking into consideration those long nights where we battle a resistant low, watching the Swedish Chef on YouTube (börk!) to pass the time. Zero thought for the need to basal test (a blood test every hour for 24 hours to make necessary adjustments to her insulin pump) They’ve never seen the look on my daughters face when she says, mom, I need to test, I feel really low. What do you say to that? No, I’m out of test strips? Wing it?

On average, that child tests between 10 – 12 times PER day. Not 6, not only when she’s hungry, 10 – 12 times per day. Her A1C proves it too, at her last checkup with her Endo, her results were 6.75 which makes me very happy considering her age and the myriad of other crazy things her body is going through right now, all of which affects her glucose readings. We can’t possibly get by on 6 tests a day, Hannah’s health depends on doing more.

Here’s the rub, they will do more, they’ll fill that script exactly as the doctor wrote it but only if we order mail order. Now, I’m sure the very nice lady on the other end of the phone has a family to feed as well but she’s not Lou. I can’t walk into that tiny little store where they know my name, know my kids, ask how Hannah is doing and genuinely want to hear the answer.

This makes me sad and I see it as a kick in the teeth to small business. I was never so embarrassed as I was this past weekend when I had to explain to Lou that I wouldn’t be ordering test strips from him any longer. For Hannah’s sake, I have no choice and the insurance companies know it. I’m curious just how big that discounted rate is to make it all worthwhile for Priority to make these kind of demands. Something tells me it’s more for their billing convenience than anything else, and that’s just wrong.

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2 Responses to Insurance ramblings

  1. russell says:

    Well, I generally haven’t commented on your posts before, and I tend to “let you have” this space free of my input. But, this one struck a bit of a chord with me – it’s well-written and nicely illustrative of just one of the many problems, here.

    I know that, for some insurances policies I’ve owned/maintained in the past, one clause I’ve seen is that any medications for any “chronic” condition (over a thirty, sixty or ninety day supply) must be ordered, mail order, through the insurance company. Up until now, I don’t think it completely registered just how-far-reaching and/or impacting that this sort of policy might be — and I’ve generally shrugged it off. It started to register at one point where one of my doctors mentioned that he wanted me to “try” a medication for a few months (though I managed to dodge that bullet, so-to-speak). It’s also kind of “caught me” with Hannah’s treatment – especially now with this new stipulation for something she clearly needs and can not do without… they have you over the proverbial barrel, here.

    Sadly, I’m sure that the discount rate really factors in to it – and their ability to preserve their ever-loving bottom line. Now, instead of you, the consumer, having some say/control over the quality of supplies you are getting (or even just simply trying to keep the manufacturer consistent), your insurance company can switch around and just give you inconsistent brands pretty much at their whim – just because it improves their bottom line (who cares about your/her continued health, eh?).

    For test strips, sadly, this is the bread and butter of their industry – they’ll happily hand you a high-tech meter for free, but those test strips (the “consumables”)… those will cost you $1 or more, each – all day, every day. And yes, they pay for the cost of that “free” meter within your first “sample” month (but now you just can’t “go to the corner store” for an emergency supply when you run out – or when you think a vial has gone bad). So much for health insurance actually being about health – now they’re happy to blatantly/effectively steal the recurring revenue stream from the pharmacies, all while continuing to improve their own big, fat paychecks.

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