Aetna HMO & refills of strips

[tcpandi]

Hi..
Does anyone else have Aetna HMO for their insurance??

I just tried to refill my testing strips.. I only have 8 left... the pharmacy called me to tell me that they can't refill this prescription until Feb 6th!! but if I want to pay $105 for them now, I can. Apparently Aetna thinks I'm testing too often.. and that 100 strips should last 30 days.

For those of you wondering, I'm testing when I wake up, before lunch, 2hrs after lunch, before dinner, 2hrs after dinner and before bed....that's 6 times.

What is normal testing procedures for all of you??

Traci

[notme]

Traci what treatment are you using for your diabetes. If you are using insulin then it is not too much testing as you can do a correction of blood sugar. However, if you are not using insulin this may be a bit much.

I use and insulin pump and I test about 7-8 times a day.

[Dad-of-Elias]

The HMO needs to follow on what the doctor prescribed. If you're using more than the prescription indicates, call your doctor and tell him/her that you need more strips per day. Get the doctor to send in a new prescription ASAP.

[rwmetcalf]

My Dr. wrote the prescription to allow for testing twice a day when I was first diagnosed. I called my insurance company and they allow up to six times a day. All I needed was a new prescription from my Dr. Ask Aetna what they allow up to. If they allow more, ask your Dr. to call in a new prescription.

Roger

[panmat1]

It is all in what the doctor writes. So I would talk to him . I pay close attention to the refill date of all my Rx's to keep on top of things. Good luck. Nancy

[sweetcheeks]

here we go again lol.... my doctor wont give me the scripts i want but the insurance company doesnt care how many i use as long as im prescribed them...


i would say get the doc to write the script for 8 or at least 6....
i want to test 6 but only test 4... because of what doc has on script... i dont wanna run out.... but yes... even tho your type 2, its YOUR HEALTH not theres you will have to argue about it probably with both doc and insurance company

[tcpandi]

Hi Nancy,
I am controlling with diet and exercise... at this point, trying to see what works and what doesn't....
traci

[labob]

If you are a member of an HMO, your doctor may be being paid on a "capitated" ("per head") basis, which is especially common on the West Coast. That means that your doctor's office gets a set payment for you every month, whether you see the doctor or not. The kicker is that whether you need no care, a little care, or a lot of care, you doctor's office gets paid the same amount. That's why many doctors who participate in HMO plans push preventive medicine -- it's in the doctors' interest to keep you healthy because the office will still get the monthly payment for you, even if you don't need any medical care.

My understanding of the industry is that in the past, there were incentives to keep the total amount of prescriptions down. I don't think that's the case any longer -- if you need strips/drugs, your doctor should prescribe them. My guess is that if there are limits on the number of strips you get per month, it's doctor that is limiting the numbers, not your insurer. When I was first diagnosed, my doctor prescribed 8 strips per day, which my insurer paid. Now that things are more under control, the prescription calls for fewer strips per day (right now it's 4 per day). But that's a decision between you and your doctor.

When I was getting settled in, though, I did test more often than now. It's worth testing a lot at the beginning -- even if you have to pay for a pile of strips yourself. The number of times that you test per day will probably go down once you get things under control, unless you are taking insulin (in which case, even if you're under control, you need to test a lot).

[lilituc]

I was not able to get more than 5/day out of them, but it could just be my plan or something. Definitely try getting the doctor to write it for more first. If that doesn't work, you may need to get a medical necessity letter for them.

[notme]

Traci, I would follow the others advice then and see if he will write a script for more strips. Gaining tight control is hard enough without trying to guess what your blood sugar does after exercise or after a certain food. I am sure a call in to your doctor might solve this issue for you.

Good Luck.