Wednesday, November 01, 2006

Insurance update

Just a very quick update on the latest from the insurance company. Yesterday I received a call back from the pharmacist at the insurance company. She says the info for limiting the strips came from the ADA. They recommend that Type 1 people test 3-4 times a day. ( They also say people with Type 1 should test "several times a day". Is that vague enough for you?) Also, they use Medicare guidelines (for my 4 year old) which recommend people on insulin use 100 strips per month. She said they allowed more than what was recommended because they realize there are days where you need to test more than others.

So, here's my problems with this. # 1) The American Diabetes Association recommends testing 3-4 times a day. There is something very wrong with this. The minimum should be 8 times a day. (before meals, 2 hours after meals, at bedtime, and in the middle of the night) The ADA needs to be more of an advocate for people with Type 1. If insurance companies are looking to the ADA for guidance then their guidance should be better and not quite so vague. #2) I have a problem with the ADA, FDA, and insurance companies not differentiating between Type 1 and people on insulin. I have plenty of Type 2 patients that are on insulin. There is a huge difference between the two. While some people with Type 2 benefit greatly from insulin, they do not need it to survive. My son needs insulin just to live. He has an organ that does not function. In order to try to be that organ for him, I have to test him more often.

So, does any of this bother anyone else? I am continuing the battle with my insurance company by filing a grievance. But, would anyone care to help me educate the ADA on why they need to take Type 1 a little more seriously?

Please let me know what you all think. I feel that the main organization that is looked to,to educate the public about diabetes is falling down on the job. I think we need to let them know this.

7 comments:

Kerri. said...

I had issues getting my test strips covered a few years ago. I was testing 10 - 15 times per day but they only covered 4 times per day. The out-of-pocket costs were astronomical. I had to have my endocrinologist write a stern "letter of medical necessity" regarding my need to test often. But this was the same insurance company that wouldn't cover my pump initially because they thought 9 - 11 insulin injections per day was a fine way to live.

I don't know how to help, but I've been there. And if you come up with any kind of plan of attack, count me in. I'll write letters, make calls, whatever you choose.

Four times a day ... who are they kidding?

Anonymous said...

I could not find a specific number for checks on the ADA site, they do have a section on tight control that says you would need to test more often, but then it also says that children should not have tight control. (Go Figure) Anywhoo I am on board to help anyway you need.
Viv

Scott K. Johnson said...

I just can't claim to understand why they would fight us for these tools that will help us avoid expensive complications? Would they rather pay for the expensive stuff down the road?

I really, really hate having to fight this kind of stupid crap. As if our daily lives with diabetes is not enough work.

Sandra Miller said...

This is ridiculous! Penny, we've gone through a similar struggle with our insurance company. Thankfully, a letter of medical necessity-- outlining that Joseph needs to be checked at least 10 times per day (because of high insulin sensitivity and nocturnal hypoglycemic unawareness) -- was enough to get them covered.

Though I've braced myself both times we've had to renew that prescription-- each time, expecting (and sadly, getting) a fight.

Please let me know if there is anything I can do to help.

Shannon said...

You've brought up really good points. I guess you could write to the ADA to persuade them to advocate on this issue.

I would be happy to send a letter as well.

Start a letter campaign? I'm on board if you think it's a good idea.

Testing is essential to help make decisions on how to manage diabetes. It should be hands down the thing that isn't limited.

Bernard said...

Can I suggest that you ask your insurance company to mail you a copy of the ADA publication that specifies to use 3-4 strips per day?

You can then take this information to the ADA (and there's probably an ADA chapter in NC somewhere) and ask them how to get this document updated to reflect the realities of today's needs for tighter control.

In the past I've been involved in several advocacy efforts with the ADA in Massachusetts and I've found the individuals involved to be passionate, helpful, and working hard to improve the lives of those with diabetes.

Personally, I have a feeling that there isn't any official document and that when you ask for a copy of it they'll break down and admit this.

Regardless it is worth getting the ADA to specify treatment guidelines that include the number of strips required for different categories of folks with diabetes.

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