Wednesday, November 9, 2016

National Diabetes Awareness Month: Can I SCREAM??? (Am I allowed to scream?)




**Another repost from the archives.
Not much has changed when it comes to dealing with insurance
 and my child's diabetic supply needs.
This was originally posted in September of 2009 when I was still
very green in the area of handling orders and insurance!"**


So yesterday morning, I realized that I only had 10 syringes left for Ashlyn.
Since we use a minimum for 4 syringes a day, 
I thought I hadn't better wait anymore.
It has been a couple weeks since I was finally able
 to send off all our new prescriptions that were for a 90-day supply
 to this new mail order company through our insurance.

I had no idea how much longer I would have to wait for it to arrive in the mail,
 so I thought I'd better call in my prescription to the pharmacy 
and go over there and pick some up.

So when I get there, the nice pharmacy girl tells me that
my prescription can't be filled because it looked to her
 (according to her computer screen)
that I or somebody else had already had 
the syringe prescription filled for the month....
6 days earlier. 
 No, I informed her, but I suspected that meant
that the 90-day supply had indeed been filled, 
we just hadn't received it yet.
Because neither of us had any idea when that shipment would actually
arrive at my house, she decided to call my insurance company to get "an override".

It took her two calls to finally get the answer that was confusing to both of us,
 "You can't get an override from us, you have to get it from them."

"From who?" I asked.


"Ummmm, I'm not sure," was her answer.


At this point, I was thinking, "Didn't you ask them specifically who I had to call? Am I going to have to do this myself?"
Another nice pharmacy girl jumped in at that point and said,
 "Did you ask for an override? They'll give you the override if you ask for it."

"Yes, I did," replied the first pharmacy girl.



"Gimme that phone," was the second pharmacy girl's response as she yanked the phone from the first (now it didn't really happen that way, although I wish in my mind it would have!!).

Again, I wait while the second set of phone calls are made to my insurance.

The second nice pharmacy girl gets off the phone and as she is walking away to her work she says over her shoulder,  
"You can't get an override on that prescription, you'll have to pay for it out-of-pocket."

Let me just say, that at this moment, my head about started to spin on my shoulders!!
I had had a previous experience where the insurance was a big pain in the tail, 
and you can read about that here.

I didn't want to repeat that whole stupid experience, 
so I chose to just go with what she said,
pay the $2.50/bag of syringes myself, 
and keep hoping that mail order shipment would
be in the mail when I got home.

(It was at this moment that I found out that my bank card was not in my purse and I had no cash on me so I had to go back home where I found the card in my husband's wallet, but that's for another time also....)

The shipment actually arrived today. 
 We were very excited because with this order 
we were to receive the pen needles which would allow us to finally
be able to start using the insulin pen.
 I will talk about that more at length in another post, 
but just know that it is something new and different 
and we've been waiting for nearly 3 months
to get this thing going.

So, this package arrives and it has everything in it we could possible need for the next 90 days.....
except the pen needles.

Let me just say that it took me a minute to regain my composure
 before I got on the phone AGAIN with these people.
The man on the other line was very nice and sympathetic, and very helpful.
He looked at his computer and asked,
 "Have you had this prescription (for the pen needles) filled before?"

"Of course not," I said, "or else I wouldn't be calling you."
(Again, no I didn't really answer that way, but I wished I could have.....I just said no.)

"Could you hold for a minute while I make a call, 
because I think I see the problem here."

So he too had to make a call to somebody I didn't care who,
 and I was put on hold for approximately 5 minutes
 before he came back with an answer for me.

He proceeds to tell me (in "Reader's Digest" format as he put it) that insurance doesn't generally
allow for two different medication delivery systems, 
and because we had received our syringes, 
they weren't going to process the pen needles.
He was very sympathetic and said he wished they wouldn't make such a broad, sweeping
policy without taking into consideration the diabetic because of the hassles
it causes those of us who have to live with it.
Of course he manually overrode this and noted it
 so we wouldn't have any further problem with it,
 and he put a one-day expedited shipment on it. 
 Of course, we won't receive it until next Tuesday or Wednesday now, 
because this all happens to us on a FRIDAY
before the Monday HOLIDAY!!

I do appreciate that our insurance provides so much for us 
(which I will go into at length in a future post also), 
and they have many, many people to handle with a myriad of illnesses.
But it's just a documented fact that diabetics who are insulin dependent just HAVE to
HAVE their supplies. 
 So why, oh why, is it not just automatically put into the systems
 to flag our cases so this kind of thing doesn't have to happen.

 Why aren't the overrides automatic?
It makes me feel like the insurance people don't trust us,
 and assume we're trying to abuse
the things they provide for us that we need to keep our CHILD ALIVE.
Why do I have to get permission to get more insulin? 
 Why do I have to get permission to get the supplies to start 
a more efficient level of care for my daughter? 
 Don't insurance companies
want to help us PREVENT life threatening emergencies that would send us
to the ER and cost THEM a ton of money??
It doesn't make sense......it makes me want to........well, you know.....
I trust you.....you can read the title of this post.



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