The Great and Powerful Oz

CurtainHi. I’m calling to update my prescription coverage and to get my refills ready for pick-up.

I was excited. Our new insurance prescription coverage was so much better than the last one and finally, I’d be able to stop cringing when I handed my money over to the pharmacist for insulin and strips.

Christel, I’ve got them all ready….wait…your new insurance is denying the amount of strips on your prescription. They are saying that you can’t have that many per month. They’ll authorize…

Oh, you have got to be kidding me.

50 strips per month.

50 strips.

Less than two blood sugar checks per day, so you better make it count. 

I thanked the pharmacy tech, wryly laughing as I explained that I knew I had to call my insurance company.

Hi. I’m calling to find out what I need to do to get an override for your ridiculous assumption that a Type 1 diabetic on an insulin pump can get by on 50 blood glucose test strips per month.

My Glenda The Good Witch demeanor was melting faster than you can say: “And your little dog, too!”

Christel, you’ll need to have your doctor call in to this special number and speak to The Great And Powerful Oz (but don’t look behind the curtain because I’m sure it’s someone who thinks Type 1 diabetes could be cured by a brisk walk and some cinnamon). They’ll review your doctor’s request and make their decision.

(OK, so that wasn’t exactly what she said. I may have taken a few liberties, but truthfully, I was conjuring flying monkeys and donning my striped socks so I wasn’t listening intently with both of my green, pointy ears.)

I thanked the customer service representative, but I wasn’t laughing anymore.

50 strips.

And Oz, the Decider of my Strip Amount per Month person doesn’t know that today, despite being on a CGM, I’ve pricked my finger 14 times today because I’ve run from 324 to 38 (and all points inbetween) in the last 12 hours alone. And not on purpose, lest you think I’m wasting strips for no good reason.

I get that Type 1 diabetics are special and that the majority of diabetics in the world don’t check their blood sugars as often as we do, but my doctor wrote that prescription for more than 50 strips per month for a good reason. She is going to have to call to justify why she wrote the script and why I need more than 1.66666667 strips per day? She went to medical school. I’m going to take a wild walk down the yellow brick road and say that Oz didn’t, and yet, Oz will decide what’s best for me.

There is something very wrong with this. Wrong.  I can’t wait until we start in on my other supplies that help keep me alive and healthy. I foresee a “first name basis” conversation with many an insurance rep in my future. Like I have nothing else to do.

Even better?

I can’t even pet Toto and say that I’m not in Kansas anymore because it’s the same insurance company we had last week. Just a different plan. It’s not like I magically became another person who didn’t need the same amount of strips I purchased before.

So, Oz?

Meet Christel. And you thought the Wicked Witch was a bitch…

 

 

9 comments

  1. a1conceive

    Dealing with insurance is a boil on my butt. Can’t stand it. Hope you get it worked out so you can maybe test your BG twice/day. Argh. I’m mad for you!

  2. fifteenwaitfifteen

    I had a similar thing happen, and it *did* take my doctor writing the Rx very specifically to say that I tested my blood sugars 10 times per day, and thus needed 300 test strips per month. Luckily, my insurance company didn’t dispute it. I hope your doc talking to Oz the Great and Powerful works!!!

  3. Katie

    It sounds like they have you coded as a Type 2. That’s a common amount to approve for a Type 2 (not saying it’s right). Make sure their systems have you as an insulin dependent, Type 1.

  4. Scott K. Johnson

    Wow.

    Because you totally need more stuff to do. You have SO MUCH free time right now to burn by spending time mediating between your doctor’s office and your health insurance. I hate these stupid little extra hoops we have to jump through so often. HATE!

    But I fear the wrath of a pissed off Christel. And before long, so will they.

  5. Carey

    50 Really?!? I don’t think a type 2 could even do well with that small amount. I had an issue where the doc wrote for 300 and the insurance only wanted to give me 250 but after a talk with my Endo and the realization that it is cheaper to let me test than to pay for a low hospitalization the decided to give up the dough. You would think they would want us to work hard at staying healthy so we don’t cost them an arm and a leg in complication costs. Good luck though I am sure they will see it your way after a bit.

  6. Scott E

    So totally ridiculous. But you managed to keep your cool towards the helpless pharmacy tech… I like that.

    My guess is that your doctor has a stack of these “justification” letters sitting on his desk. He can just fill in the name and send it off. You’re certainly not the first. My advice is to play by their rules first, and if that doesn’t work, raise hell. You also might investigate the DME route. I find getting my strips as DME rather than through Rx, I pay less. Only caveat: I need to use their in-network supplier (i.e. EdgeofinsanityPark). That might work too.

    You’ll win this thing… I know it. Cause you’re smart and logical and sensible, and the insurance guy is a nincompoop.

  7. Scott S

    This is an issue many of us have dealt with, and the process differs from one insurance company to another. What’s more, its something we need to get a pre-authorization for (no claims made after-the-fact) but no one can tell you where that pre-authorization needs to be sent! What I find scary is what the future may hold when I’m old enough for Medicare … oh, wait, the Great Oz has spoken and by the time I’m ready to retire, there won’t be Medicare anymore because the enormous Baby Boom is retiring now. Maybe a flying monkey can help!

  8. Sara

    I just ran into a bit of this too. My endo wrote the scrip for 8 times a day (I would have preferred 10 but I don’t NEED that). I went to fill it and they gave me one box for the month. I refused to take it. Then the clerk clicked away at the computer and figured out that insurance would only approve 6 strips a day not 8. Okay, but if you do the math that is two boxes not one.

    I took the two boxes and called my insurance company the next day. There is no form to appeal, I am just supposed to write a “free form letter” and get any supporting materials from my doctor. They will assign a rep and will guarantee a decision 30 days after the rep is assigned.

    OR they could just give me the medication that my doctor has prescribed in the way he has prescribed it. But why would they want to do THAT?!

  9. Pingback: Around the Diabetes Blogosphere: June 2013 Edition : DiabetesMine: the all things diabetes blog

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