New insurance

I started a new job about 7 weeks ago and one of the things I was most excited about was the insurance (in addition to many other things.)  I still love the job, btw. 🙂     We compared the new insurance to D’s insurance, which we were currently on (and not a very good plan, unfortunately) and chose to go with mine, even though it was going to cost a considerable amount more per month.     As we all know, our diabetic Rx’s are not cheap so that had to be a major factor.

With D’s insurance I was paying $600 every 3 months for just my insulin and test strips. *sigh*  That may not be a lot to some people (YDMV).. but I had been on a plan for the prior 7+ years where I paid nothing for any of my diabetic supplies (goodness I still miss that job/insurance).  I was definitely spoiled.    With my new job, the way the benefits summary was written, it says “Diabetic supplies are not subject to copays.”  So I read that to mean that there are no copays for diabetic supplies, right?

Ugh.

I dropped off my insulin Rx…. “We’re sorry, this is not covered.”  Whaaaaa?   I asked them to re-run it.  And then it came back approved but only for 4 bottles, with a $40 copay.  Uh, that’s $10 a bottle and it’s not going to last me for 30 days. Yikes.  But I was running low, so I took it.  And the problem now will be when (hopefully not IF) they get it fixed in the system, insurance will not fill anything else before that 30 days is up.

Then a couple of days later, I dropped off my Rx for test strips.  Go back to pick it up and “We’re sorry, this is not covered.”  Huh??? Since we’d just had this song and dance a few days earlier, I asked them to re-run it.  They said they already had, and it’s still not covered.  Wow.  I had a freak out moment thinking to myself (ok, fine, I was talking out loud to myself in the car) “We are paying $xxx a MONTH for this insurance and it’s not even going to cover my diabetic supplies???”   I got home and vented to D … he said I needed to calm down, there’s nothing I can do right now about it.  He was right.  But I was still internally freaking out.

The other thing that sold me on our insurance plan was that the benefits summary read that I’ll have a $10 copay for all dr’s visits and all other “Diabetes Management” costs are paid at “100% per allowed benefit”.  So let me back up for a minute.. I work in HR .. my background is primarily in benefits so I would consider myself very knowledgeable in interpreting these kinds of things.  However, my first question back to our benefits rep was “what is considered an ‘allowed benefit'”?  She didn’t know.  *sigh*  So I asked her if she could please find out and send me info on it asap so we could make our decisions.  She was able to get some info from the insurance company and it seemed pretty self explanatory   That is why I was so shocked to have the issues with the Rx’s.

I sent her an email this morning, with a copy to our boss, explaining the Rx problems and asked her to please look into it (and hopefully FIX it) quickly ….. fingers crossed!!!

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About Shannon

I am a wife, a mommy, and a Type 1 diabetic (since '92.) I have had two successful pregnancies - one of which was with twins. I wear an insulin pump- - off and on for 17 years; currently on the Medtronic pump and CGM. I am not a medical professional, nor am I giving medical advice. I am just sharing my day to day stories of someone who lives with this disease every day. My ultimate goal is to raise awareness.
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2 Responses to New insurance

  1. Scott E says:

    I really hope you can get this all straightened out. Nothing’s more frustrating than opting in to a health plan to find your stuff isn’t covered. Especially if they tell you it would be beforehand. (Tip: they’ll tell you ANYTHING to get you to buy-in!). Fingers crossed!

    • Shannon says:

      Thanks! I found out late yesterday they only cover Novolog, and Accu-Check and One Touch. None of which I use. :/ My boss has talked to the broker and they are supposed to call me today. So we’ll see what happens!

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