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msmichellemille

insurance coverage and supplies

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msmichellemille

My 2 yr old son was diagnosed two weeks ago yesterday. We'd been pretty okay living on the supplies sent home with us from the hospital but recently needed to get more test strips and syringes. With everything going on I did not imagine for one second that our insurance company (Blue Cross Blue Shield of Texas) would NOT cover diabetes testing supplies! :eek:

Obviously we will pay anything we have to in order to keep our baby healthy but it *is* rather expensive and something will have to come OUT of our budget to cover this new cost.

I'm so disappointed in our insurance. I wonder if there is a way to convince BCBS to change their minds and cover us? Anyone have a similar experience or really, REALLY good at dealing with insurance co's?

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princesslinda

I can't imagine an insurance company NOT covering supplies for a type I diabetic! If your insurance is through your job, i'd speak with someone in HR about your situation and have them check with your insuror.

 

If supplies truly aren't covered, i'd check the websites of the pharmaceutical companies that make whatever supplies you're needing and see what they offer to help defer costs.

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msmichellemille
I can't imagine an insurance company NOT covering supplies for a type I diabetic! If your insurance is through your job, i'd speak with someone in HR about your situation and have them check with your insuror.

 

If supplies truly aren't covered, i'd check the websites of the pharmaceutical companies that make whatever supplies you're needing and see what they offer to help defer costs.

Thanks for your input. So far...I've done all you've suggested. I am basically out of luck. (though our insurance *will* be covering supplies in TWO-THOUSAND-NINE!!!!:mad: ) Helps out alot now, huh?!

The medical co that makes the meter did hook us up with a discount card and pays part of our cost of strips. Every little bit helps!

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Mich

It sounds like a mixup in communication. Many times testing supplies are covered under another part of the program. My pump was covered under "durable medical equipment."

 

First, make sure you have a prescription from your doctor for the meter and strips. You will need a lot--like 8-10 a day becsue your little guy can't tell you how he feels yet. Find an advisor at the 800 number on the back of your card, or use the rep from the place you get your insurance and don't let up until they do it.

 

In insurance, the squeaky wheel gets the oil, and there's no squeakier wheel than a concerned mom. ;)

 

Mich

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msmichellemille
It sounds like a mixup in communication. Many times testing supplies are covered under another part of the program. My pump was covered under "durable medical equipment."

 

First, make sure you have a prescription from your doctor for the meter and strips. You will need a lot--like 8-10 a day becsue your little guy can't tell you how he feels yet. Find an advisor at the 800 number on the back of your card, or use the rep from the place you get your insurance and don't let up until they do it.

 

In insurance, the squeaky wheel gets the oil, and there's no squeakier wheel than a concerned mom. ;)

 

Mich

 

Ya know...I heard that phrase, 'durable medical equipment' one of the many times I called different insurance agents! (i was hoping if I talked to enough different ones, someone would help so I've called a million times!)

I had no idea what they meant by it; I thought 'Durable' was a brand and because I was being bombarded with info at the time I somehow managed to not ask more about that....

Looks like I'm gonna be on the phone most of the day again! :D

thanks

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gettingby

I'm so sorry you are having such a problem with insurance. I have BCBS here in NC. They cover my strips and insulin. I found out that BCBS has a program that you may be able to use that is supposed to include strips and insulin at no cost to me (no co-pays whatsoever). All I had to do was visit the BCBS website for my state, fill out a questionaire, and send it in.

Keep at them. I'm sure your state has some sort of mandate on covering diabetes supplies. Keep calling until you get the answers you want and need.

Good Luck. :)

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poodlebone
My 2 yr old son was diagnosed two weeks ago yesterday. We'd been pretty okay living on the supplies sent home with us from the hospital but recently needed to get more test strips and syringes. With everything going on I did not imagine for one second that our insurance company (Blue Cross Blue Shield of Texas) would NOT cover diabetes testing supplies! :eek:

Obviously we will pay anything we have to in order to keep our baby healthy but it *is* rather expensive and something will have to come OUT of our budget to cover this new cost.

I'm so disappointed in our insurance. I wonder if there is a way to convince BCBS to change their minds and cover us? Anyone have a similar experience or really, REALLY good at dealing with insurance co's?

 

Are you sure that your insurance doesn't cover it? Did you get prescriptions for everything you need? Texas is one of the states that DO require coverage of diabetes supplies. See here:

 

Diabetes: State mandates for insurance coverage

 

Scroll down to Texas and click on the link there to view a PDF file with all of the gory details.

 

 

Note that in order to get anything through insurance you must have prescriptions. The doctor should be very specific in how they are written. He can't just write "1 vial of insulin". He's got to write how many units/day of each type (or for pens). Same for test strips. He can't just write for 200 strips; he's got to say "test 6 times a day". Have him write for more than you're using right now because you do not want to be caught short.

 

Get prescriptions for insulin, test strips, syringes or pen needles (or both if you're using pens & vials) and lancets. You should also get a prescription for a glucagon emergency kit (for severe lows).

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msmichellemille

Yeah we were sent home with prescriptions for all of that good stuff. We took them to our local pharmacy. The pharmacist then told us NOTHING was covered under our insurance (same as I was told by the HR person and various insurance telephone agents) and we had to pay for it all---with the exception of the small discount on his test strips we got with a card from the manufacturer.

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Keezheekoni

One thought that I have reading this is that your insurance may just not cover the strips for the meter you have. When I had Aetna they only allowed OneTouch and AccuChek. I had a Freestyle Flash that went with my pump, so I had to get special, written permission from them *yearly* in order for them to cover my strips.

 

You might need to look at BCBS's website and check out the formulary for your plan. Every plan has a different formulary, I've found. Search the formulary for "test strips" and that should tell you which ones are covered under your plan. If your insurance plan doesn't have a "prescription coverage" then you're out of luck. Most do, but I know a few HMOs that exclude prescription coverage.

 

I also know that on my insurance I can't use Humalog, I have to use Novolog, if I want the "generic" copay category. Novolog costs me $10/month, whereas I'd have to pay the "brand" copay, at $65/month for Humalog.

 

Definitely look at the mandate for your state, linked above. The only way your insurance can get out of the state mandate is if your insurance plan is "self-pay" through your company. Otherwise, the insurance company *must* cover your child's supplies. If they don't, call your state's insurance commissioner and then follow up with a letter to them.

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Scrabblechick

Right, Rikki. My insurance (BCBS of Alabama) will cover Accu-Chek and One Touch monitors.

 

I'd look into that specifically, Michelle since you're with BCBS Texas. It could be the same thing. But make sure the actual prescription specifies either the Accu-Chek or the One Touch, if those are the covered brands, not just "meter."

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Mom Of "J" T1

Hi,

Hugs and prayers to you for the recent diagnosis of your son. My son, like yours, was 2 when we found out in 1999. We also have BCBS and it always covered everything with a copay. Now, I am know nothing of TX, but in PA children with diabetes are covered under state medical insurance. I, unfortunately did not find this out until about 2 or 3 years ago and it took until this past December for my son to finally be covered. Having a medical pays for everything, no copays. Obviously, there are limits and loop holes and a lot of paperwork. Had I known this 7 years ago I would have saved at least on all of the copays. My son, just yesterday, started on his first pump. Our BCBS covers it completely. I say research and find out through your drs and endo people if it is available. I was never told but never asked because we had coverage. Also a couple of tricks. My son uses humalog and lantus. These are both "pen" available. Well you can get 5 pens for the same copay as 1 vial (at least I could) so I would get the pens but still use syringes because my son was not happy or comfortable with the pen caps. That is basically 5 months worth of insulin for 1 price. Once again, check into it. All states are different, I assume. Good luck to you and if you ever need to vent get in touch with me. I remember being in that sinking ship. It does turn around and all of a sudden you will find it isn't a matter of him being a diabetic kid but rather a kid that just happens to be diabetic.

 

"J" mom

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Superjew78

I am sure if your supplies arent covered by your insurance, that your son would be eligible for state assistance. Thats something you can look into.

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