Warning: This post is a venting post....I'm sad, angry, and frustrated right now....I'll post it for now, but may delete it when I gain my composure!!
We just received a notice in the mail telling us the insurance is now approving 200 test strips and 200 syringes. This is still 100 less than my doctor is prescribing……and at least 50 less than what we actually use in a month. I am frustrated with our insurance. How do they decide what is "medically necessary" for my son? Are they just sitting in some office thinking "Well, they're asking for 300, we only want to pay for 100, how about we offer them 200…sounds like a good number." How can they say only 200 is what is "medically necessary"? LIVE WITH ME FOR A MONTH!!! How am I supposed to determine how much of the "medically necessary" insulin I'm to administer to my son without testing his blood? I just looked back at our log for the past 15 days…128 tests!! ALL MEDICALLY NECESSARY!!! Double that number we are looking at around 250-260 a month. I am just trying to understand….we've paid our premium for how many years? Being self-employed is tough enough, and we even contemplated not having health insurance at times to make ends meet, but always thought…."NO, we just don't know what could happen…it's good to have." But what good is health insurance if it doesn't pay for what is needed to keep you or your family healthy? TO KEEP THEM ALIVE!???
Well this may seem like a little thing…so what? "At least they'll pay for 200"…and yes, at least they upped it a little. But what about the insulin pump….we have to go through the same process. It has to be deemed MEDICALLY NECESSARY!!! I just can't see them approving the pump at this point if they aren't willing to see the need to check blood more often in a small child!!! How do I scream on paper?
Wow!!! After crying my eyes out for a bit, and typing this post….I feel some better. I am assured through scripture that "My God will supply all [my] needs according to His riches in glory in Christ Jesus"..(Phil 4:19) I'm may not see HOW He'll supply, but I'm assured that we will be supplied with exactly what we need. As a side praise….yesterday we received a card in the mail with $50 cash in it. No name, no return address, just a note card with the money inserted in it. We put it directly into J.J.'s savings account we set up for his medical needs. That will cover the extra 50 tests we'll need for this month!! Thank-you God…and bless the tender heart that sent it!!
7 comments:
What kind of machine do you use?
Vent away (:-) I understand, in the past I've actually had to fight to get my insulin approved for a formulary. Test strips, as you have learned, are a never-ending battle. But they're so vital. When I was first diagnosed I used a urine test kit--only good if you want to know what your levels were hours after the fact.
Take care and hope the weekend lifts your spirits a little!
Lynnea,
Try having your doctor contact your insurance company to get them to approve the supplies JJ needs. This has generally worked for me when my insurance has only allowed me their standard amount of supplies. Your doctor will also need to be heavily involved when it comes to getting the pump approved - as a general rule. You're right; God will supply your needs.
Try to have a fun night out. You deserve it.
I'm so sorry that you are having such a hard time. This disease is bad enough without having to deal with crappy insurance companies.
When my daughter was diagnosed we were 6 days away from our health insurance being active. Really, really bad timing.
Penny,
We use a OneTouch Ultra2. This is what our nurse educator thought our insurance approved, but she didn't realize it was self-employment insurance.:-( We might have to find one that has cheaper test strips.
Donna,
Our doctor sent J.J.’s medical records and 30 pages of “clinical evidence” as an attempt to get our insurance to approve the quantity they want J.J. to have. I’m not sure if they would have to make a phone call or not? I’m tempted to fax our log book records as “evidence”.
I was asking about the machine because I was hoping I had a box or two of strips we don't use anymore to send you. But, we've never used the OneTouchUltra2.
I just read your latest post and I hope everything will be cleared up with the insurance company. I had a very similar experience when Riley was first diagnosed.
I called and talked to people until I was blue in the face. I even got the ADA involved. Turns out, once I got through to the right people that Riley can get as many strips as he needs every month. We just have to pay our 10% for whatever we get.
Thanks also for speaking about praying. I often forget how much easier things would be if I stop trying to deal with it all on my own and give it over to God.
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