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[IP] Advice for taking on the Insurance Company
Hello All. Sorry I haven't posted much, but have been in the middle
of a career move and haven't had much time to read and keep up on the
When I got my MiniMed in March, I had to get prior authorization from
my Insurance provider and had to meet all of their qualifications
which went off without a hitch. They authorized it and I had my pump
within two weeks.
I had a maximum out of pocket expense of $500 total which includes
all of my prescriptions for testing supplies and insulin that I had
to pay up front which I did. Now, for the rest of this year I don't
have to pay anything for pump supplies or testing supplies.
But now, I'm in a dilemma and need some advice.
For the last 3 years I've used a OneTouch Profile glucometer for
testing and daily management, and when I was on Multiple injections
it was fine and gave me everything I needed. But when I started pump
therapy I discovered that it really didn't have the things I needed
for day to day management.
Not too long after I started pump therapy, MiniMed and Accuchek sent
me the 'free' Accuchek Complete monitor and I tried it out for a
couple of weeks and discovered that it was by far a better machine
for daily management. Not only that, but I discovered that my actual
readings were roughly 75-80 points lower than the readings I was
getting on the OneTouch.
After calling my CDE and my doctor and getting new prescriptions for
the new strips, when I went to my pharmacy to get them filled they
came back as 'not authorized' from the Insurance company.
I called them immediately and asked the Diabetic case manager what
the deal was. Seems that my insurance company last November signed a
contract with LifeScan that they would only authorize claims for
LifeScan meters and supplies. She told me that I hadn't been notified
because I was already using LifeScan products and they didn't see a
need to notify me.
After discussing with her in detail of why I chose the Accuchek
machine, she went ahead and authorized a 3 month supply and to let
her know when I need another authorization.
Well, lord and behold, I call the insurance provider last Friday only
to find out that she is no longer with the company and get this RN
that is taking over all of her claims who knows absolutely nothing
about the diabetes other than what it is. So I go through the whole
song and dance again and was told she would check into it and get
back to me.
Monday morning she calls and informs me that she had done some
checking and that there was almost a $50 difference for a 30 day
supply of strips and that they would apply the amount they would pay
for LifeScan and I would have to pay the $50 difference. After
talking with her I found it very odd that there was that big a
difference in the price, so I did some checking myself. I found that
there is only a $14 difference between LifeScan OneTouch strips and
Accuchek's new Comfort Curve strips. I also compared the price of
OneTouch against AccuChek's Advantage strips and found that there
was only a $2 difference in price.
Tuesday I called her back and gave her the pricing information that I
got and was told they would investigate it further.
Today, she calls and informs me that what they have decided to do is
authorize a 6 month supply of strips for my AccuChek machine but that
at the end of the 6 months I will either have to switch back to
LifeScan or pay the full price for the AccuChek strips.
I kind of got the feeling that it was their way of just trying to
blow me off and hopefully keep me quiet for 6 months, but its gotten
to the point where I'm not going to just accept that and move on.
In my opinion, they should be thankful that I'm willing to check as
often as I do and that it shouldn't matter to them what the difference
is. In the long run, its saving them money. You would think that
after paying $4500 for my pump, they would want me to use whatever
resources I possibly could to get the greatest benefits of pump
therapy. Do you think they would rather I just stop testing all
together? I don't think so.
To throw one more worm into the mess, I just recently found out from
my MiniMed rep that my insurance company is trying to set up a
contract with MiniMed authorizing only MiniMed pumps for new pumpers.
So they are going to issue MiniMed's pumps, MiniMed is going to send
out Accuchek machines, and they aren't going to cover the supplies
I'm in the process of building up a campaign to launch against the
insurance company and hopefully raise some hell and get something
changed. I know its a long shot, but I refuse to sit back and let
them tell me what's better for me, especially when they have people
making decisions that have no clue about the daily life of a
diabetic and the things that we must go through.
I would really be interested in any advice, suggestions, etc from any
of you on how to move forward with this.
Please email me directly as it will be easier for me to read your
Thanks in advance.
Tracey E Dutcher
Pumper since 3/24/99
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org