The ins and outs of insurance

3a118a835fd0d6d253f49acc9ed5697aA Bedtime Story: Insurance Heartache and Stress.

Knowing what the insurance will pay for and what they won’t and when the insurance covers everything.

My lesson the hard way.

Recently my son’s continous glucose monitor (CGM) stopped working.  And my descriptions of  stopped working is it would not charge, blink or the OK green light.  So of course I went about calling our CGM company for the arduous process of replacing the CGM.  After a long conversation we decided (the company rep and myself) that it was truly dead. With this fabulous information the next step was to await the doctors new prescription. Obtaing this elusive prescription seemed far reaching. First I had asked for the company to acquire the needed paperwork form the physician and not the diabetic educator, as we had not visited with her recently. However the company decided to go about this in their own way. They proceeded to contact the educator and she would not fill out the paperwork because she had not seen him. Now The educator we have seen in the past is FABULOUS; simply my son really prefers the male doctor. Because of this we then played a waiting game from November to January. And so the story continues.

While we are in waiting questions such as does a CGM make or break a diabetic day? Really, why not just go old school and just test all day long? But for my son it can make or break his day and week and month. His blood sugars tend to be wildly all over the place causing him to test his sugars more than the 8-10 times a day. Also he has recently started in a running club and driving.  So having a CGM that will shut off if he cannot detect a low blood sugar is a life saver, literally.  Besides saving his fingers from repeated testing. Moreover, he is able to simply look at his pump prior to sitting behind the steering wheel, at schimagesool, or before running. His CGM can make or break his daily management of his diabetes causing us to miss it horribly.

With the passing of months of mourning we have finally heard from the company!YAY! There is no paperwork form the physician. UGH. The holidays are here! I have called the physician’s office, they already have the paperwork done and faxed back; and we finally have the prescription to the company, creating a no out of pocket payment with our insurance. SIGH–calm and relief set begin to take over. Or so we thought! A few weeks pass. Mind you we are in mid-January, and the company calls me and states they just received the fax from the doctors office. Huh, you mean the one that was faxed in December? (You thought this tirade was complete and our family’s stress was finalized.) This then lead to a 2 hour phone conversation with the company. Me stating and restating that I was informed by the doctors office they had confirmation recite from the fax before the new year began. The representative and manager stated their paperwork demonstrate otherwise. What is a family to do!

The End of the Story

The company did not have the paperwork in hand before the end of the year so it is to be billed on 2016 insurance! UGHHH. Lesson learned (The financial lesson). Don’t wait for the company call and harass everyone until its done right! He has his CGM and all is now going smoothly and with lots of basal rate changes, very few lows and a green light indicating all is well with our CGM.

Moral of the story

Know your insurance and the companies you are working with. you can save money in the end and the ability to maintain a full head of  hair at the end! Happy New Insurance Year!

 

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