UHC plus OptumRx = pain in the rear


(Amanda) #1

I’ve had this medical coverage since October 2014. I got authorized to start pump therapy in April or May of 2015. I have the Accu Chek Spirit Combo, which calculates boluses and delivers them with just a few button presses on my meter. Great! My latest A1c is 7.2, after having been much higher for quite some time (that’s a long story). So, insulin pump therapy seems to be working great for my T1D.

For the past year, I’ve been going in circles with UHC and OptumRx, after receiving a letter from OptumRx that it will no longer cover testing supplies. I’ve called them, asked them what to do. The last time I talked to one of their reps, I was told that I could file an appeal, but it probably wouldn’t work. That’s probably true…the first time.

I’m severely annoyed, because if you don’t know, Accu Chek Aviva Plus test strips cost $189.99 for 100 strips. I have FSA, but I would rather not spend all my FSA account on test strips, which would easily be done.

I’ve been reading through my policy whatnot, and it doesn’t seem like OptumRx will cover literally any test strips through my plan. Which seems a little strange, because there have to be quite a few people with diabetes on my employer’s coverage. But, UHC will cover a new pump, if I recall correctly.

It’s frustrating. I don’t want to go back to the pens, insulin pump therapy really seems to be working for me.


(joe) #2

@liketheairport hi Amanda,

I know this is a couple days old I just wanted to say I hear you and that insurance can be frustrating.

Every time I get a new script I check my coverage, because that’s how fast things change. and I also just lost a 2nd appeal and then a “mediation” step and now get to pay a $1,000 unplanned bill. yay!

one question though, I get that the integrated meter is easy and calculates bolus and wires it to the pump… but your pump allows you to enter a bolus amount - so while the meter input is faster… you could still do a calculation and input the bolus yourself using a walmart “reli-on” meter and strips? I mean the walmart strips are 18 cents each by comparison.

I find the programmable basal rate the best part of my pump anyway so I wouldn’t toss the Pump out a window if my insurance carrier wouldn’t cover my test strips…i’d just change test strips, just a thought?

good luck.


(brighter1085293) #3

Are you on an employer-sponsored plan? It seems strange that UHC would cover a pump (and the supplies), but not the blood glucose testing supplies necessary for it to be effective. Will the plan cover a CGM? Perhaps the letter was just about Roche testing strips. I suggest asking for a copy of the Drug Formulary and using Google to find details about T1D coverage. For example, I found this: https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/PA_Non_Form_Diabetic_Meters_and_Test_Strips.pdf

You might also check with JDRF and American Diabetes Association advocacy and your state Insurance regulator (sometimes called “Department of Insurance.” The Affordable Care Act is still the law and it requires insurers like UHC to cover pre-existing conditions like T1D.

As an alternative, consider OneDrop at https://start.onedrop.today Given most insurance plan deductibles, OneDrop’s annual subscription for unlimited strips at $399.95 can be much cheaper than using a pharmacy benefit manager (PBM) like OptumRx, especially since you have an FSA.

Be aware that UHC has an exclusive arrangement with Medtronic that may eventually force you to switch, especially since Accu Chek meters are no longer being sold…


(CarlaAnn) #4

http://www.jdrf.org/press-releases/jdrf-health-insurance-guide/


(Amanda) #5

Employer sponsored plan. Don’t have a choice.


(Amanda) #7

Guide doesn’t help. I’ve looked. My employer doesn’t have these resources. HR doesn’t give a crap. UHC also doesn’t give a crap. I’ve been around and around about this and all they tell me is that employer has chosen this, and my employer doesn’t listen.


(Dennis J. Dacey, PWD) #8

Amanda @liketheairport, there most probably is a very simple explanation; I suggest that you speak with a Customer Care representative at United. I’ve had coverage through United for many years and have found that BG Check Strips are covered for only specific meters - the United Preferred. I also presume that a letter was sent to you last November [with a copy a copy to your prescribing physician] telling you what meters would be covered and that the new meter is free; at least United gave me plenty of warning, and with followup.

A few years back, United supplied me with a a Countour Link Meter which is designed to wirelessly connect with the new Medtronic pump that was shipped with the meter; subsequently United notified me that coverage was ceasing on the Contour BG Check strips [cost per strip $0.62 each] but that certain Accucheck and OneTouch meter strips would be fully covered. Right now, every 90 days I receive, at $0.00 cost to me $1,457 retail cost OneTouch Verio check strips - $1.82 each.

Bottom line, we use our Insurer’s preferred brand or we shell out our own money.


(Amanda) #9

And UHC doesn’t care that I’m using an old pump. UHC doesn’t give a care about its subscribers. They just want money.

Also, OptumRX isn’t going to do anything. They won’t cover OneDrop. Only OneTouch, which defeats the purpose of having the pump connect wirelessly to my meter, doesn’t it?


(Amanda) #10

I’ve talked about 10 times to customer care. They didn’t send me any of that. All they send me ever is EOBs. That’s it.


(Amanda) #11

You do realize that employers get to pick what they’ll choose to cover through your insurance plan, right? You realize that UHC isn’t the same for everyone, right?