Insurance and test strips


(Charles) #1

Ok, I’m gonna rant a little but still want to know what others think.
Alrighty then. As a T1D, we are required to monitor our blood sugar regularly each day. This is a given. If you have a CGM, it has to be calibrated. In my case with two test readings 12 hours apart. And we are supposed to check levels in cases of supreme highs or excessive lows by testing, manufacturers statement. Everybody following me so far?!

Why is it that I have to fight the insurance to approve the appropriate number of test strips that I have to use each day?
They currently have only approved me to have 100 test strips for a 3 month prescription.
Simple math here. Average month 30 days. 4 test strips per day ( bare minimum). 30 x4= 120 per month Right!
3 x 120= 360 total test strips Right!
Dr asks for 400 test strips for three month Rx. I get denied when last year I was approved for that very amount. Now I have to appeal and yada yada. To see if I can get this fixed or I’m gonna have to pay for the strips outta pocket.

Now I did not change insurance carriers. I have Medicare with the Blue Cross supplemental insurance.
First question!
Why the hell do I even have to be approved for test strips every year?
I use the same equipment. Dexcom G5. All that changed was the calendar. I’m still T1D, nothing changed, and yet I can’t even get approved to calibrate my equipment with enough test strips. This not even enough test strips, if I did not have the cgm. Then I would need minimum of 5 test strips per day!

Does the insurance not realize that it’s cheaper for me to use 50 test strips a day than one hospital visit? Retail cost of test strips is under $2.00 each. We all know there is a mark up on this. Most probably the markup is around 2.5 times the actual cost of the item! Why in the world should this be an issue???!

I have wet Maclear degeneration. The cost of the medicine (Ilea), is $4000.00 per injection, per eye. For the medicine only! No dr fee, office visit, nada. Insurance covered this and still covers this without any argument at all for the last4 years!! But I can’t get enough test strips to literally keep myself alive on a daily basis?
Question 2.
Anybody else have this issue? If so, let me know please?

Thanks for “listening”.
Charlie


(joe) #2

how exactly does the doctor “ask”. my script says “TEST 10 TIMES EVERY DAY” with a medical order like this, my insurance covers the pharmacy to put 900 strips in a bag and send it to me.

My previous script said “Test 4-6 times a day as needed” and guess what happened? 4 * 90 = 360 strips came in the mail. 'cause he said 4.

I had to demand the script to be written as a command, it solved everything. good luck.


(Charles) #3

Good lord… it is a pain. I hope I can get this straightened out. I’ll try that see if it will work. Only god knows when messing with insurance.
Oh yeah the asks part… yesterday bad day… I was ping ponging all day long. Nothing worked the way it usually does. I’d drop then eat/drink. Blow sky high and drop right back down. I blew 12 alarms yesterday. Three lows on the dexcom.
I’d settle down for about an hour and wham back under again.
I remember one incident pretty well. Was at 114 watched a commercial break. Alarm went off showing a 68. Drank a soft drink. Blew a 220. 30 min later… it was a rough day.
Got some sleep feelin much better today. It’s been a more normal day.
Thanks for the reply.
Anybody else have issues with this?


(steve) #4

Unfortunately, this is an issue with some insurers. Make sure the script is written for # of tests per day. Your doctor has override authority if you can get them to flex their muscle to note that it’s a medical necessity. That’s a signal to the insurer that they are recommending a possible deviation from standard coverage in the best interest of the patient. Another issue that is not helping is the marketing hype of the insulin pumps and CGMs. They are being marketed directly or indirectly as artificial pancreas and no longer needing to manually test to dose. The insurers are seeing this and trying to squeeze on the supplies as less necessary. That’s not the official stance, but guaranteed that’s where the insurers are going with the thought process. The technology is wonderful, but no where near being a pancreas replacement or enabling people to stop manual testing. Keep fighting for what you need!


(Charles) #5

I hear ya. It’s so stupid that the carriers focus on the one thing that makes no sense at all to focus on. Sugar management is essential. I seriously believe that it’s the type 2 problem that creates issues. I cannot believe how many medical offices I have been in and most of them try to list me as type 2. I very clearly state I’m type 1, but I cannot believe how many times I have had to have them change their records. I even had to have it changed right before I went into have surgery! I was having a second surgery on my eye. They had it right the first time, but the second time they had it wrong.
At least theEndos office is with me. It’s just so stressful that I have to go thru this every year. I get it changed and approved. And as soon as the calendar changes I’m right back at square 1. Same crap all over again.
I really wondered if this was a major issue with everyone else. The last thing T1Dd’s need is more stress. Like we don’t have enough!
Thanks for the reply!
Anybody else? Just trying to see if it’s a big problem out there or if it’s just me and my luck

Thanks
Charlie


(jjmnav) #6

Yes - I would fight them for what you need.
As a backup - as a cash customer my last order of Prodigy Autocode Test Strips 300 Count cost me $32.19 purchased on Amazon. Comparison tests I have seen do not place them close to the top of Accuracy list, but they & Dexcom agree pretty close. I’ll soon find out what my new insurance co-pay will be a new meter and test strips (and if they provide adequate quantity) then decide if I’ll just put my Prodigy in the closet or continue using it instead.


(Mary) #7

It’s the same with me, but it’s being on Medicare that makes it this way.

When diagnosed 4 years ago with an A1c of 10.6 and T1d at age 61, my then-insurance covered me for my (Dr. requested) 6 test strips a day using a regular bg meter. I tested 4-5 times per day and had extra strips for testing/rechecking lows and highs. The freedom to check my bg as frequently as I needed helped me to lower my A1c to 6.2.

Last June I aged into Medicare and learned they only allow 3 strips per day for type 1s UNLESS you jump through a bunch of their hoops: a 30 day log EVERY 90 days proving you tested as many times per day as you are requesting, signed by you & your dr.; two dr. office visit notes stating why you need to test that much (and apparently “so she doesn’t die from a low”, “to keep her from being hospitalized with dka” and “to help her maintain a good A1c” aren’t valid enough reasons); how long you need to test (until there’s a cure, or a transplant, or until I die?); and a recent A1c, and everything has to be cafefully worded or they will reject the request.
The last time I sent a new prescription and log I averaged 5.5 strips usage a day. Medicare only approved it for 5. Since June my A1c has crept up to 7 and now when I feel I may be going low I am afraid to use a test strip for fear I’ll run out.

I have spoken with supervisors at medicare and the mail order pharmacy but Medi- “Care” doesn’t, and the pharmacy says they have to submit to m’s rules.

I know medicare fraud is a problem, but, really? I guard my supplies!


(Charles) #8

That’s is exactly what I’m talking about! It’s not like we’re testing for no reason. We literally are testing to live. It makes no sense to me. The cost of the strips is negligible compared to the cost of one hospital visit. Even after copay of any kind.
It’s not like there is a black market for test strips!! LOL. But seriously why can’t we all band together and push Medicare to approve higher numbers for test strips. If enough people write thier congressmen, would that help or would just be a waste of time?
Mary, you and I are in the same boat. I was diagnosed 4 yrs ago as well. Except when I started I was 13.7 A1C. I’ve dropped to an average of 5.7-5.9. I’m actually trying to raise it some because of nighttime lows. Trying to see if I can minimize the amount of lows during the night. I’m hoping to stop having to wake up enough to go eat. I’d rather sleep. Only getting sleep for 2 or 3 hours a night gets old real fast. I eat 4 times a day most days. I dont want to eat that much every day, but I have to or I’m up every hour eating junk. And the alarm going off and ne waking everybody up from me fumbling around getting food.

Thanks for the replies. I’m fighting the decision already. I got dr office to resend stuff after I wrote a letter to go with it.
Well see!


(wadawabbit) #9

Most test strips can be bought over the counter, with the RX required solely for insurance purposes; so I have occasionally purchased strips in bulk off eBay. It cost me up front, but due to the quantity I got a good deal, and it may be worth it if you have to pay out of pocket for your steps, or need some while you’re fighting with insurance.
Of course be sure to check the expiration date on the ones you’re buying.


(Charles) #10

I have purchased them before as well. You migh.t have missed my point, or I didn’t make it very clear. Let me restate it.
The point I’m looking at is this: Why do we have to fight for something that is cheap but still effective? We are preached sugar control, sugar control!! Know where you are at, test as often as you need! Then the insurance company says sure test all you want, but don’t exceed more than x amount of strips. It’s ludicrious! I understand insurance fraud an all, but testing is essential to our well being. I find it absolutely infuriating that the insurance co. Thinks that by limiting test strips is effective. When the cost of one hospital visit is far greater than dozens of test strips!! This is insanity on thier part.
I have extra boxes of insulin, but god forbid if I use more than the allotted amount of test strips!!
I also find it very infuriating that I have to get approved just because the year changed, when the day before I was approved for the correct amount. This is stupidity at its finest!!
If enough people, make a big enough stink about it, we should be able to change this. It’s not like we are wasting money for no reason. Testing is kinds essential, but yet to limit the one thing we can use to help control sugar levels, creating better health for our already damaged bodies is flat out insane.

I fail to see how this limitation saves them money. I haven’t even talked about strips that don’t work!! When it takes 4 or5 just to get one reading! I know that it is far better than it ever was before. I just can’t see how this one thing can make the insurance company more money than it already makes. It’s not a nonprofit industry!

But it is the point that I have to supplement ,pay otta pocket, to have the amount of test strips inorder to use a fully approved piece of equipment. It’s thier responsibility to see that we get the proper amount of supplemental equipment to use the approved equipment. Yet we are made to feel like we’re commiting insurance fraud just to get what it takes to properly use equipment they approved!

Thanks for the reply. I do purchase if I have to. But why should I have to. I’m also on disability, it’s not like money grows on trees.


(Nancy) #11

Did ins. Co. mention pre-authorization? That’s what I ran into. Pre-authorization from endo stating it was uncontrolled type 1 got my strips. As a fellow Medicare recipient also with MDG (dry), but with chemo costs of $57,000 for 4 each session I have to wonder at the overall oversight by business geniuses (obviously not employed by CMS). Good grief!


(Charles) #12

Boy yeah. The pre-authorized thing. I was pre authorized until the 10th. The Rx was to be filled on the 11th. Couldn’t fill it because it was not authorized. Had my appt been one day earlier it would have been filled. Literally one day difference!!!
With MDG (wet), I have had no issues on any medicines etc. expensive surgeries, nada. Cost for eye shots is only $10.00 / eye to me.plus copay for dr. The meds for injection are $4K / eye, dr office visit 1K, total per visit somewhere near 10K. That’s each month. MThat part wonderful. Except for needing it that is. But try and get enough test strips…Geeezzzzz.


(Roger) #13

Medicare bureaucrats need to keep their jobs. I deal with the same thing.
T1D Roger


(Charles) #14

That’s why I think if enough of us can band together, we can make them sit up and listen. And at least try to stop the insanity of thier decision.

It gets even better. I had to pick up tests strips by Rx. Could only get 100… figures right. On the outside written on the Rx strip test 4 times per day! Impossible to do so I can test for 25 days st that rate…Geezzzz…


(scdiver) #15

I have always had the same issues but recently starting using an Abbot Freestyle Libre system. Its not a real CGM but has a sensor that lasts 10 days, (soon to be 14). Under my Blue Cross, the reader cost $65, the sensors are $25/ea. It uses test strips also to calibrate occasionally. So you can check your BG a 100 times a day if you want. No strips needed. I keep about 25 strips on hand for lows and highs but only use about 2/week. Don’t know if Medicare will cover it but it sure made a huge difference for me. Better control, know how fast food and insulin works, I recommend it highly. So it’s $75/mo for the sensors but for me that is a small price for better control. My 2c.


(Charles) #16

I’m with you there! Management is the key! I have the Dexcom G5. But it requires testing/calibration 2x per day. Each calibration requires 2 tests. Hence 4 test strips per day.
It checks every 5 min and I can check anytime I want or need. Just have to have enough strips to be able to test with.
Costs for me are about the same. Technically, it would cost about $100.00 per month. But I use the sensors for two weeks and no problems, so cost drops to about $45.00 per month.
Little over a dollar a day. Plus I can share up to 5 people my readings. Have to have iPhone, but I had one anyway, so no issue there. But it allows me freedom, my wife gets the same alerts I do and if they last too long she can call/text to check on me. If I don’t respond, she knows to come home and find out what’s going on.
Just that the stupid insurance thinks controlloing amount of test strips is smart business. Saves em money! Idiots!! Let me test my butt off and keep my butt outta the hospital, dr office etc and it will be cheaper!!
It happens every year. Calendar changes and it’s time to go to war to get reapproved for what I had last year. Why?! I t makes no sense!! Either financially or medically!

Well gotta call insurance today and see if I got reapproved again. I’ll spend the next couple of days seeing if all the i’s were dotted and the t’s crossed to see if I can get reapproved.

Thanks for the reply
Charlie


(Charles) #17

Figured I’d update on this. Called BCBS about this problem and a few other issues and here’s where we’re at. Hurry up and wait. I got denied first time due to insufficient information! How in the world did that happen! I had someone at BCBS file it and ask for the strips I need etc.
So all customer service ppl are not the same as they like you to believe!
I called and spoke to a rep that has helped me in the past, with great results by the way, and he’s is working on it for me. Waiting on him to give me an update for everything as soon as he is able to get the information.
So, how about anyone else? Share your issues with absolutely necessary need supplies and insurance woes. The more we make a united stink about it. The sooner we can get it fixed.
Later
Charlie