Thursday, February 08, 2007

Tired

I’m tired, just plain tired.

I really, really, really need a good night’s sleep. Michael and I have been getting up 2-3 times a night to check sugars for the last 16 months. And, there’s no end in site. You see, if I don’t have the alarm set to get up and check sugars, then I won’t sleep anyway because I’ll lie there and wonder what his sugar is all night.

I’m so tired I’ve slept through the alarm a few times. Evidently, I’ve been hitting snooze over and over again in my sleep, because eventually the alarm will wake me and it will be 30 minutes or so later than when I meant to get up and check.

But, it’s a necessary evil. We still have occasional nighttime lows. And, here lately, nighttime highs. Two nights ago we kept getting up and bolusing sugars in the 300s. Finally, at 5 AM I decided I’d had enough. As much as I hated to, I changed his set. (I found out he had a bent cannula)

Riley awoke to the stick of the needle and started to cry. When will it ever end?

Also, I’m mentally tired. Not from the numbers, but the other aspects of this disease.

I am still fighting a battle with my insurance company, a battle that has been going on for almost 5 months now.

I’m still having trouble getting Riley’s strips. I am able to get his 150 a month just fine. They are billed under pharmacy. But, the others I need every month, that’s another story. The rest of strips are billed as DME (Durable Medical Equipment). Don’t ask me why. It makes no sense.

The ones I get under DME I have to pay for up front (around $250), then the insurance is supposed to send a check to reimburse me for what is covered (90%). But, I have yet to get reimbursed for any strips that I have purchased since October 1st. And that, my friends, is a whole lot of freaking money.

I have been given several reasons why I haven’t received the money yet. The last reason is that the strips were purchased out of network, so now I may not get any of the money back.

I have someone working on getting me my money. But, in the meantime, I had to find a pharmacy that is in my network.

I went to this pharmacy yesterday (after calling Dr. M and getting all the paperwork faxed that I would need to get these strips), and was told that the insurance was denying the strips saying I needed prior authorization. This is how all my trouble started in October.

I tried to explain to the pharmacist that I did not need prior authorization and that he needed to bill it as DME. He just looked at me with this dumb look on his face. He called Medco (who handles the pharmacy benefits), but I told him to call the State Health Plan (who handles DME). He wouldn’t do it. And, there is not another pharmacy in my town that is in-network. (My wonderful pharmacist who I have been using for years is in the process of filling out all the paperwork, so he will be in-network.) But, until then, I’m stuck dealing with incompetence.

So, I have a call in to a lady at the State Health Plan to try and get her to explain to the pharmacist how to put the strips in his computer, so they will go through and I can get them. Until then, I’m running dangerously low on strips and may have to purchase even more with my own money.

Tears are streaming down my face now, hot tears of anger and frustration.

I feel so helpless. What else can I do? No one seems to want to listen to me when I explain to them why it's so important that I get these strips. I've written letters, the ADA has written a letter, but it's all falling on deaf ears.

Sometimes I look at people and wonder why they don’t fight for what they need. Why do they just roll over and play dead? But, now I know.

They’re tired, just plain tired.

4 comments:

MileMasterSarah said...

I went through something similar with my pump supplies around 7 years ago. It was a nightmare getting it figured out. This sucks.

Sandra Miller said...

Oh Penny, I'm so sorry you have to fight this battle.

It's hard enough, without having to fight for the supplies you need to manage this disease.
((Hugs))

(And, if it helps at all-- I'm tired, too.)

George said...

I hate hearing this stuff. It makes me so angry.

I am so sorry and I hope things smooth out soon. I swear, if I ever win the lottery I am buying CGMS for all of the OC. I hate this disease.

Nicole P said...

Penny -

I guess the ADA letter didn't help? Can you email me and let me know exactly what's going on. I think maybe I can help.

Talk soon.
Nicole