How an unexpected $1000 made me mad
An envelope arrived in the mail the other day. It was from my medical insurance company.
In it was a check made payable for close to a thousand dollars.
I knew what it meant, and I was fuming.
You see, I had recently ordered a new batch of test strips from everyone’s favorite medical supply house. I had just updated my insurance info with them (the division my wife works in had spun-off into a different company, so all the group and member numbers changed, but the company stayed the same) twice (because they royally screwed it up the first time). But after those hassles were resolved, they ultimately told me that I had no out-of-pocket costs and that the order would go out the following day.
It did, and I received my test strips with a statement saying my Balance Due was zero. Just like I’d done it all year long. Life was good.
But the check — it arrived because the portion of the order that my insurance company deemed to be MY responsibility (which was all of it) had been forwarded to my Flexible Spending Account administrator (the one where you contribute money tax-free to be used for medical expenses). That purchase fully depleted my account (and then some!) and they cut me a check for the balance. So the money I got was really mine, but my money shouldn’t have been spent on this order to begin with.
I have no intention of paying full price for these strips, and certainly not the above-MSRP that Edgepark seems to use as list price.
I called the insurance company. They told me that strips are now covered only under the prescription plan and no longer as DME (durable medical equipment). That’s a surprise change, but not one that’s worth the fight right now. I have neither time, backup supply, nor energy for that.
I called Edgepark to see if they could bill the order as a prescription rather than as DME. They can’t. But if I didn’t want to pay out-of-pocket, they could send me a return mailing label and I could ship it back and my account would be credited.
Oh, and you know how they were led to believe I would be covered for the strips? Through a website. “Ask the Magic 8-ball,” I suppose.
Anyway, I now had to call my endo to write a prescription to the mail-order pharmacy for test strips. I pressed option 1 (for prescription refills) and obediently answered their automated questions (who are you? whatdya want?) after the respective beeps. The automated voice told me they’d respond within two business days.
They were actually quite prompt. I know this because I got an email from my endo’s office that afternoon inviting me to log-in to their private and secure messaging system with a username and password (which took several tries to remember) so I could read a private and secure message they had sent me. A real PITA.
The message confirmed that a prescription for Bayer Contour strips was submitted to my mail-order pharmacy. But my meter doesn’t use Bayer Contour strips, it uses Bayer Contour NEXT strips. Bayer made a lot of fine accomplishments when they made my meter and strips. Coming up with a name wasn’t one of them.
So I called the endo’s office again, pressed the menu option to reach the front desk and explained the situation. The nice woman who answered asked me to please hold while she retrieved my chart. A little while later, a different person came on the line and I again explained the situation, after which time I was placed on hold while she retrieved my chart. Finally, receptionist #2 told me she’d speak to the nurse and have her fix the prescription.
A little later, an email came telling me to log into their private and secure messaging system, at which point I learned the proper strips were prescribed. The earlier message had mysteriously vanished.
I worry about what may have happened on the pharmacy’s end.
So now I wait … wait for the label to return three months’ worth of strips to vendor number one and wait for an identical quantity of the same (hopefully) type of strips to arrive from vendor number two. I’ve also got a $924 check at home, screaming “cash me!!”, but that might get me in trouble with the IRS or something.
There’s a trend towards developing technology to make the lives of people with diabetes simpler and less stressful. Right now, I’m not convinced that any amount of technology could do that, but a tiny bit of common sense could work wonders.
Meanwhile, I’ll be dusting off my old OneTouch meter soon and dipping into my leftover supply of those strips, because I’m quite sure the new ones won’t arrive in time.
Posted on August 8, 2013, in Diabetes, Personal and tagged frustrations, insurance. Bookmark the permalink. 20 Comments.
Every time I read a horror story about insurance in the US I quietly freak out. Why is it so damn difficult down there?
I’m sorry, this is added stress NOBODY needs to deal with
Sadly, this is so common. =( Good luck.
UGH. I don’t know why they can’t just make it simple for us. As if we don’t have enough crap to deal with with diabetes. Dealing with insurance is like a whole additional chronic illness!
My old insurance suddenly stopped covering strips as DME and didn’t bother to tell me either. Unfortunately problems with insurance and Edgepark are so common that I’m not surprised anymore.
I had to fight with an Edgepark rep that I had met my deductible, but they charged me and my insurance for an order of pods. So disorganized!
Dealing with insurance makes me weep. Absolutely nothing is simple. I recently had to switch insurance and went to order some supplies. I was told what I needed would cost $115 per box. I had previosuly paid $29/box. I said “sorry, I guess i won’t order it.” Without missing a beat the customer service rep said “we can get that price down. Does $75 work?” Seriously? Is this what healthcare has become in the US- a racket where patients get shaken down by a used car salesperson on the phone? Incredibly depressing.
This almost made me cry. These things are so hard for me to untangle. Especially the equations that involve durable equipment. You’re very, very good at this! For what it’s worth.
My brain is in a knot.
Can you re-deposit the check directly into your HSA? Or will you be an outlaw and spend it on snacks for your spacious snacks drawer?
My probation ends on Sept 1 and my new job’s insurance kicks in then. I went through so much grief trying to get all my Rx’s established on my current insurance that I almost want to continue paying for my COBRA just so I don’t have to deal with it. Sad times.
I went through almost this exact same issue with Edgepark in 2010 (only, they hadn’t already gotten payment from me, they were trying to get a $1,000 payment from me when my supplies *should* have been covered 100% by insurance. One month everything went through insurance fine, then the next month something changed (without notice to me) and Edgepark billed me to pay for my entire order. It took about 30 phone calls between me, Edgepark, & Cigna, and almost a year before it all got straightened out. And while I didn’t pay a dime, the time, stress, and energy I wasted on it (including the high blood sugars from frustration) cost me dearly.
My concern is that all I do for my daughter, she will have to do for herself some day. I know she can test her blood sugar, count carbs, bolus, correct, change her site, analyze how she feels (high or low?), change her settings… BUT fight the insurance company??? It is overwhelming! How will she manage? She is leaving for a semester abroad next week. Getting her enough insulin has taken 7 phone calls, 2 emails and a visit to my employer. My favorite part of the experience was when I was told there was NO WAY she could get insulin before the refill date to take along. HELLO! It is a life-saving medication. SHE NEEDS IT TO SURVIVE!
Oh no oh no. I never thought of this. We need to train them to deal with bureaucracy Crud, crud, crud.
But how exciting–the trip! The trip will be fantastic!
My daughter is 19, so I’m thinking of this more and more. I should have made her make the phone calls, but I just couldn’t. As for the trip – yes – it will be wonderful and she is only excited, not nervous, at all!
Arghhhhhhhhhhhhh. I was fuming for you while reading this.
My issues with Edgepark have been one of inaction. I call, tell them what I need, and say that cannot run my card until they have verified with insurance. They say they will call back the next day, and then… Well, you know. It has been the only way I can assure they won’t bill me and not the insurance company.
yuck. we have edgepark for our dexcom supplies. i’ve yet to see any bills or papers regarding this. at the beginning they said our insurance would cover it all. but they’ll probably bill me for one million dollars at the end of the year. i don’t like their “on hold” fake radio show warning me that breast pumps are not returnable. it makes me think of edgepark as a warehouse mostly filled with crusty old breast pumps, and that’s why they’re so defensive about it.
I was going to bring up the whole Edgepark breast-pump obsession in this post, but I figured lots of people wouldn’t make the connection and they would think my remarks were in poor taste. During my sophomore year in college, the person in the dorm room next to mine had such an obsession, and it was creepy to say the least. I don’t want to be that person.
I can’t stand insurance. It stresses me out. Now I have a high deductible plan and more stress than I need. Sorry you’re getting such a headache. I hope you get it straightened out soon.
Oh man, I’m so sorry that happened to you Scott. 😦 Hopefully things get straightened out quickly!
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