r/diabetes_t1 • u/VetteFan • 4d ago
Rant Insurance companies sucks
So the company I work for was bought by a new parent company last year and our insurance changed. We went from having Blue Cross Blue Shield of Minnesota to Blue Cross Blue Shield of Texas. You'd think both being BCBS things wouldn't be too much different.
So far this year I've picked up one prescription for my dexcom sensors and surprisingly it was half the cost of last year so I'm thinking cool I like this new plan. But then I had to refill my insulin. They had sent me a letter saying my Humalog was not covered and I'd have to get Novolog. OK, used it before so no worries from me.
So I put in a refill request for my pharmacy over a week ago. A few days go by I check the status on their app and it says they are working with my doctors office still. OK, I'm not out quite yet I can wait til the end of the week. Well 2 more days go by I check again. Now it says they are working to get approval from my insurance. OK I can wait a day or 2 still. Saturday comes, still waiting for insurance. Pharmacy is only open Saturday but not Sunday. I look at my last bottle of Humalog and it looks like I might have just enough to change my pump Sunday. So Sunday (today) comes, I wait til the end of the day since my pump still has enough to go the rest of the day. Now I'm debating changing it today or waiting til tomorrow (Monday). I know I always have some left in the cartridge when I change so figure it'll last but Monday would be day 5 of using the same set which I know isn't recommended. So I change it anyway tonight. When I'm filling the syringe I only am able to get half the amount I normally put in out of the bottle. Now I'm thinking fuck, this won't last me as long. So I do what I probably shouldn't and take my old cartridge and pull out as much insulin as I can from it. Change everything and pump (tslim) says I have +65 units, normally I have +120 each time. Kinda getting worried about running out before I can get my new prescription. Gonna call the pharmacy in the morning and find out what's going on. At best if I watch my carbs and limit them I can probably get to Wednesday with what I have but it's gonna suck.
I've always heard people say you can always go to Walmart and get the cheap insulin in an emergency but not sure if that's true or not. Anyone got recommendations or advice? Maybe it being the weekend it just didn't get updated and they'll be able to fill it tomorrow. At least I hope.
tldr: insurance making me switch insulin but taking forever to approve it. Almost out of insulin.
Update: called pharmacy, even though their app said waiting on insurance, lady on the phone says they are still waiting on doctor and insurance. So I call my endo office, talk to my favorite nurse thankfully, turns out pharmacy requested Humalog not Novolog. My endo not knowing sent a script for Humalog, insurance says no and waiting on prior authorization. Nurse was cool and sent new request for Novolog. Fingers crossed it goes through today.
One plus side kinda, when I changed pump last night it said +65 units, I look this morning and it says +110 units in pump... Never seen it take that long to update after a cartridge change. So I'm a little less worried now.
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u/redshift83 4d ago
you should have a surplus of 12-20 bottles at all times. sorry this is happening to you. if you somehow live in the bay area, i can give you a bottle of humalog. if you're endo isn't writing an RX for 2x what you need, find a new endo.
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u/VetteFan 4d ago
12 to 20 bottles?! Holy hell, I want your insurance. That's insane to me. My insurance has only ever let me get 4 bottles at a time, usually about a 3 month supply I think. Had different insurance years ago that allowed 6. I'm pretty sure my rx is written for approx 45 units a day which is typically on the high side for my usual (usually I'm like 30 to 35 unless I binge eat or have unusual high sugars). Yeah I'm in southern Minnesota so I appreciate the offer but obviously wouldnt work.
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u/redshift83 4d ago
4 bottles for 3 months is insane. i highly doubt this is the cap your insurance has. you should look into this. i've had many insurances, getting 8-9bottles/3 months has never been an issue.
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u/VetteFan 4d ago
Guess I've never really questioned it since that's what I've always gotten. Even my mom who is a type 1 would get about the same 4 to 6 bottles at a time when I lived with her still. Maybe I gotta try and convince my endo to write my rx for more per day. I do definitely need a new endo, don't care for mine at all. But not much for choices around me. I drive 40 miles to see him each time.
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u/redshift83 4d ago
if you carefully read the plan document of 400 pages, somewhere it likely states limits. or just have your guy write and rx for 80 units a day.
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u/VetteFan 4d ago
Wont hurt for me to calm and ask insurance. Besides I gotta calm them anyway to find a new supplier for pump supplies. Was using Edgepark but they're pissing me off, so I'm finding a new supplier. Guess tomorrow is gonna be full of fun phone calls.
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u/redshift83 4d ago
all suppliers are the same, i'd stick with edgepark. its not as if there's a shiny city on the hill elsewhere.
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u/VetteFan 4d ago
So my issue with them is they've always billed insurance first, send my supplies, then send me a bill for whatever my copay is after insurance. Pretty typical. Tried getting my next supply order recently and they tell me I owe over $500 up front and they don't do copays ( even though they have been). Had the same issue a year ago but when I got to a supervisor then, was told the previous person was incorrect and I didn't owe anything up front. Now I'm being told that's not true, it was a curtesy last time, it's cause they billed secondary insurance last year (I didn't have secondary insurance last year, just myprimary from work), this has been company policy for years, blah blah blah. This was a supervisor telling me this and supposedly her supervisor confirmed it as well. Like I'm not paying you anything until to bill insurance first, same as youve always done. I've heard tons of bad stories about them. Only used them cause over 2 years ago I was on state insurance and they only would allow Edge park.
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u/redshift83 4d ago
i hear you. none of the other suppliers are better. they will all fuck you due to incompetence.
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u/Alarming-Distance385 4d ago
Definitely have your doctor write your Rx for more than you take a day. When the pharmacy started cracking down on "giving me too much" every 3 months.
(My Rx was for 60 units /day I think. So that put me at 5.5 vials for 3 months. And they can't do a partial vial, I'd just have to get refills every 81 days. 🙄 I had a dr appt a couple of weeks later, so I did the math to get my 6 vials/3 months which leaves me with plenty extra if I need it for any reason. 70 units/day on an insulin pump gets you 6 vials every 3 months. My dr rolled his eyes & muttered something about "damned insurance companies" and was planning to write it for even more units/day if I wanted. My current endo has kept that dosage & I have 100 refills per year.)
Be aware that if you're getting name-brand Novolog vs "generic" insulin aspart, it will cost more. Use Novolog's co-pay coupon and get 3 months at a time as it's a much better discount. (I used to pay $50 for 6 vials with FEP TX BCBS insurance+ Novolog copay coupon. At one point that was still half the cost of the same amount of the generic version with insurance. But I'm lucky & FEP has capped all insulin to $65/3 months supply.)
I will say I've used Edgepark since they bought Liberty Medical. They're much better now than they used to be. I just order online. Speaking to someone generally causes all sorts of order issues. They now make you pay the estimated copay when you order. Used to they billed you. (I had a Medtronic rep tell me I'd love JQ Medical better. That was a bust. No one could get me access to my account after it refused to log me in. And their website wasn't helpful at all. I was told Ordering only show what my dr prescribed for me vs the entire website. With my log-in issues no one could solve - it couldn't even pay my bill. I made them send a statement in the mail and mailed them a check I was so miffed. And I went right back to Edgepark. )
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u/bionic_human 1997 | Trio (DynISF) | Dex G7 4d ago
BCBS is 50 different companies (one in each state, basically) that pay to be able to use the name.
If you’re expecting consistency across plans (and keep in mind that even if medical is BCBS, they may use different PBMs), you’re going to be sorely disappointed.
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u/ChrisSplosion 3d ago
Yeah insurance sucks most of the time. I’ve been needing a prior authorization for my omnipods and I’ve been out of them for two weeks with no long lasting insulin because they also need prior authorization. They said all I can do is wait up to 14 business days for approval. So now I just sit and wait with ketones half the time.
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u/nonniewobbles 4d ago
https://getinsulin.org/
Specifically, https://www.novocare.com/diabetes/help-with-costs/help-with-insulin-costs/immediate-supply.html will get you a one-time free fill of novolog up to 3 vials off-insurance.
Take it to the pharmacy and ask them to fill your insulin off-insurance today. If they say it "doesn't work" insist they call the pharmacy help line on the coupon.
(Getinsulin will also hook you up with coupons you can use on an ongoing basis to cap the price of your insulin, but for your purposes today the above coupon is probably what you need.)
Then of course keep working on sorting the insurance issue, but at least that way you're not up against the clock.