Insurance Melt Down.....

Being self-employed for the past 12 years we understand the trials of finding insurance that we can afford. Over the years we've generally increased our deductible to afford the premiums. When our premium hiked up over twice it's "normal" hike this year, my husband called to see if there was anything we could do. Unfortunately with J.J.'s diabetes the options are limited, or extremely complicated. We decided to stay in a holding pattern until after the baby came and we had time to really evaluate all our options...especially in light of the new laws.

So you can imagine....well maybe not.....being prego has a lot to do with this story.....my total distress when I opened up a package from "our" (I use that term loosely since we don't even know this guy....he was assigned to us we think!)... insurance agent which had a cover letter stating that we needed to fill out and sign all the highlighted areas and mail it all back with a canceled check ASAP. I was in a little mini-shock. I was thinking Jason HAD to have called this guy....we wouldn't get a packet like that without a call from him to move forward!!

As I thumbed through the packet I was flooded with thoughts of CHANGE......and all that means with J.J.'s diabetes......will he need new insurance, what about all the prescriptions? My mind didn't shut off with all the foreseeable HASSLES that would ensue with a change in insurance. I was... to say the least... OVERWHELMED.....and in tears, thinking...."Doesn't he get this? Doesn't he know that I can't handle this change right now? Doesn't he see that I will take the brunt of this change, and right before a baby....there's no way I can do this....."

O.K....so yeah....I will admit the tears flowed quickly mainly from baby baking, family, & life STRESS....(it was 4-H entry day.....any 4-H mom would understand the STRESS of that!!:). But I was literally bawling. Couldn't stop crying. I did try to call and text Jason, but knew that if he didn't answer he was in a meeting he couldn't leave. So I began to look at the packet more closely.

Some of it didn't make sense. The agent had highlighted the date of renewal which is 6/1/2010, and another line that made it look like we didn't have insurance. But I knew for a fact that our insurance is automatically renewed yearly.....said so in fine print....we just needed to ignore the letter.....which we did. But the way the guy highlighted certain aspects of the letter(dated April 2010).....it made it seem like we were insurance-less.

The other weird thing was that the agent filled out a good couple of pages of the application FOR US!!! Some of it was untrue. Like the very first question is : The applicant and/or any person to be insured has or ever had any of the ineligible medical conditions? The agent circled "N"......well, a quick glance on the insurance website of ineligible medical conditions shows diabetes mellitus as ineligible!!! Another question asked if we'd ever had coverage from this company before......he stated no, but we have had coverage!!

There was so much in the "packet" that didn't make sense for our situation.....it's not a simple look at premiums & deductibles....we have to evaluate the coverage in light of J.J.' specialist visits, his lab work, his prescriptions, etc.

So....anyway, I decided to move on with my day....when Jason called I asked him an indirect question about insurance. He said he hadn't thought about it since he looked at it months ago. I replied, "So you haven't talked to any insurance agent in months, and especially in the last day or two?" NOPE was his answer. I explained to him the package I received and what was in it. He was not a happy camper.....a little miffed with this insurance guy.....and promising me up and down that he didn't authorize nor ask for this CHANGE.

PHEW!!!! Well....I don't have to be upset with him then!!!:) And we know we don't want to deal with this insurance guy in the future......but still this has me wondering about all the new laws, and how they will effect us, and J.J. especially......also has me contemplating all the "research" I'll need to do to ensure we get what's in our (and J.J's) best interests. Sigh......OVERWHELMING!!

BUT.....I can put it out of my mind for now....stick with what I know......and thank Mr. Insurance Man for the sinus headache!!!

Officially Pumping.....

Look at him.... all smug with the pump on his hip!!:-)

It's hard to believe this day is here. Who'da thought? Almost 10 months into this and J.J. is off all those nasty daily injections!! YAY!! Of course we face new, but different challenges I'm sure, but we are excited to see how this works for us. So far it's been amazing.

We got up really early to make it to St.Paul by 9 am. The news had us (read ME!) worried with all the riots and blocked traffic because of the RNC. We ended up being 45 minutes too early....oops!!

The first couple hours we went over the basics and made sure all the numbers were confirmed with the endo before we went "live". The pump seemed to be working properly throughout the set-up process, which was encouraging.

Finally, it came time to insert the cannula. I was somewhat nervous because I had requested numbing cream when we used the trial pump. This time he would feel everything. He really wanted the site in the stomach, but the CDE said there just wasn't enough fat. So the bum it was.



My hands were shaking.....I don't know why, I give him 4-6 shots a day, what's one poke? He didn't even flinch. I was shocked. I'm not sure if it was because two other guys were also starting at the same time and he was being brave, or he really didn't feel it all that much. At least this first one wasn't so painful. For that we are very thankful.

We were given two brand new meters that link with the pump!! It's always fun to get diabetes freebies!! We just thought we weren't going to be able to use that feature. The strips are the same ones we've been using this whole time, so that's an added bonus.

We took his blood sugar and out of nowhere the pump beeped then showed the result. Yay....that worked too!!:-) It showed a high number.....mainly because they take the kids off Lantus the day before so they can start on the pump. We gave our first correction bolus AND IT WORKED!! He dropped from the 200's to the 70's.

Today has been all a'flutter with NEWNESS. Like.... going to McDonald's and bolusing BEFORE he ate...and NOT giving an injection!!! How about changing clothes? Or "going poop"? J.J. came to us wondering how he was going to use the bathroom with his pump on......good question. We're still trying to figure all that out.

For the next 3 days we have to check his blood every 3 hours around the clock to make sure everything is working properly and the pump settings are accurate. Really this is nothing new for us. We were already in this habit, so it's not so much a big deal.

There's a feature on the pump which can be set to alert us when we need to check his blood after giving a bolus. So we told J.J. that if the pump starts beeping to let us know. At one point hubby looks at me and says, "J.J.'s pump should've gone off by now. Hasn't it been 3 hours?" We called J.J. in from playing outside and he says, "Mom, Dad, the pump has been beeping at me.....dooot, dooot, doooot." We were like "YEAH....that means you have to GET US, DUDE!!"



We are just so thankful for this day, and want to thank everyone who has prayed for it. We also want to thank the generous person who gave us the pump.....what a blessing....we cannot thank you enough.....God bless you!!

Please continue to pray for the adjustment.....we know we'll have problems along the way. Also pray for continued provision. Pump supplies (unfortunately) come out of the durable medical portion of our policy, instead of prescriptions. So basically we pay out of pocket for his monthly pump supplies. We hope to never have to make a decision between money and his health.

Now......off to figure out how to sew pump pockets in his clothes......and find a few belts....the weight of the pump causes his pants to sag.:-(

Doin' the Happy Dance......

Our N.E. called in another prescription yesterday for the test strips. Last night hubby calls pharmacy....all is well. This morning I get an automated call from the pharmacy that says our prescription has been delayed. WHAT???? I call hubby who spends an hour on the phone to find out that the delayed prescription was for the lancets....those weren't increased to 300. PHEW!!! We have plenty of lancets....it's those blasted test strips we need.

This afternoon, I drove up to the pharmacy, and for the first time since J.J.'s diagnoses I was able to get the full prescription for 1/4 of the cost!!! YIPPEEE!!! I'm doin' the happy dance!!

Rejoicing......

Although our internet is still being halted by our internet company I can rejoice that there is a library close enough where I can access the internet if I need to!! WOW!! What speed!!!...now I know what I'm missing....I thought it was Blogger that was slow....!!

Anyway.....what we are truly rejoicing in today is that the insurance company approved all 300 test strips!! YAY!!! Thanks to everyone that prayed!! God is good!! We are just so thankful it was a "communication error". I've been afraid to call, but we needed more strips so my husband called today. The first lady he spoke to didn't know anything, but grabbed the guy I talked to the other day, and they both walked down to the prescriptions department to see what was going on. They came back saying the prescriptions department just approved it, and to give them 15 minutes to get it in the system!!! YIPPEE!!! And here I was thinking such bad thoughts about that company, now I could kiss them!!

Another praise is from yesterday....I wrote it last night but couldn't post....so here it is:

February 14, 2008
Yesterday J.J. decided to do his own finger poke. I got there just in time to see him getting the blood…he forgot to get the monitor ready so I had to help with that….but it surprised me that he did what he did. Today he did it all himself…(and I remembered to get pictures this time!!)…he really goes all out…milks his arm and says “I’m getting it Mama, I’m milkin’ it!!” I thought I’d just share some pictures of this monumental day!!

Hannah has now checked his blood for us as well. Sarah has done it a few more times. Allison was about to check today, but I put the breaks on …she’s a little rambunctious and not as responsible….J.J. and Allison’s proximity in age makes it difficult for them to accomplish things without some sort of “Uh-huh…..Mom said….I told you so…stop that….MOMMMMMM!!” scenario….so for now Allison will not be checking J.J’s blood for us….but thanks hon, for your willingness!!

A Ray of Hope....

"The king's heart is like channels of water in the hand of the Lord; He turns it wherever He wishes."  Proverbs 21:1

 

Last night Jason and I took some time to really pray for, well...a whole lot of things, but specifically J.J. and the situation with the hospital, health insurance etc.  I was thinking of the above verse….if God can change a king's heart He can surely change the heart of this insurance company and make things happen in our favor if He so wills.    An hour or so later I was quilting.....and when I quilt, I think.....and it dawned on me that this whole matter with the test strips may just be a miscommunication.  The insurance company has a set policy to approve 100 test strips for a diabetic.  That's just their standard.  If we wanted more we had to have the quantity pre-authorized.  So here we've been waiting and waiting for the answer, but I believe our endo's office sent the request in for 200 thinking the insurance company already approves 100.  The total then would be 300!!

 

I just got off the phone with the insurance company and they have the request for 200.  I explained the situation and he totally understood and is sending through another pre-auth for the 300 total.  So, maybe, just maybe it's all just a big miscommunication.  It probably won't be as easy as this guy told me, my endo's office will probably have to resubmit everything with the 300 TOTAL and blah, blah, blah.... but at least it seems like maybe this insurance isn't as difficult as I first suspected and there is more hope that they'll approve the pump!!!

 

I just so wish I had trusted God sooner!!  Well, even if the insurance doesn't approve the full 300 I believe I've learned what I needed to….God just wants us depending on Him, trusting Him, having a humble and contrite heart before Him.  So, even though the saga continues, and we still don't have a "final answer"….there is hope, as there always is…. if we trust God.

Health Insruance STINKS....A little venting...

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!!

 

Now….I have to compose myself, try my best to put this all aside and get ready for a night out with my husband….our first "date" since the big D-day!!  Any advice on covering up puffy, swollen, red eyes??     

Just added frustrations.....

I've spent the past couple of days dealing with our insurance company, the hospital, and bank!! UGH!!! It doesn't make my mood cheery that's for sure!! We've never had anything major happen medically in our family...besides babies, miscarriages, broken toes, ear infections, etc. So to have to deal with not only diabetes, but the insurance and the medical entities wanting their money is very draining.

We are still fighting to have the insurance pay for the test strips. Our Endo prescribed 300/mo. but the insurance only wants to pay for 100. They cost us $1/strip. And we are finding that we do go through close to the prescribed amount each month. We've had to contact both our insurance and our clinic to follow up. Just amounts to a lot of time on the phone. I found out yesterday that the insurance does have the information they need now, but it's in review!! We are so praying that they approve the test strips.

We finally got the hospital bill yesterday as well. I called this morning to set up payments, and was given a ridiculously high amount.....for us right now, anyway....the lady was snippy....not a great way to begin my Saturday!!