Here’s my damn (#DiabetesAccessMatters NOW) story

I still owe a follow-up to The Three Little Pigs.  I know that. But this whole UHC+MDT thing is full-steam-ahead with momentum, and I feel I have a moral obligation to keep it going. So my planned post about what is wrong with the cost of healthcare (the big picture) will have to wait.

In the meantime, I urge you to head over to http://diabetespac.org/access-matters/ and submit your story of a battle you’ve had with your insurance company. We need people – people with influence and decision-making power – to know that these practices of insurer-playing-doctor are unethical and they are wrong. I trust that the dedicated folks at DPAC will get to work making sure the stories get heard, loudly.

Here’s my story. Feel free to leave yours in the comments as well (after you post it on the DPAC site) for all to read.


Last year, I tried (unsuccessfully) to upgrade to a new insulin pump/CGM combination. My insurer was known for denying such requests as they were deemed “experimental”, but I believed to have sufficient justification so I pursued trying to obtain the device.  My first battle was with the manufacturer itself, who knew that this claim would be denied and didn’t want to participate in the battle – I was encouraged not to fight it and to simply buy the pump outright, in all cash. I refused, and instructed the representative to submit the authorization-request to my insurance. A month goes by, and I found out that the representative ignored my wishes and did NOT submit it, because she knew it would be denied; it seemed she couldn’t be bothered with the hassle.

After finally getting the authorization-request submitted, I got a denial in the mail, as expected. The denial letter instructed me how I could appeal, and separately how I could obtain information used in which to reach the conclusion of a denial.

The appeal would have been rather useless without knowing the basis of the denial, so I made that request. After months went by without a response, I attempted, numerous times, to call my insurance company. I was transferred to fast-busies and disconnections, and referred to call incorrect phone numbers. Eventually, I had to choose the automated options to identify myself as a healthcare provider, and then to plead with the representative not to transfer me back to the black hole I had been in previously. Eventually, after re-sending my request, I got the information in the mail.

The basis for the denial was rather weak.  My endocrinologist chose not to participate in the appeal-process. His role is to practice medicine, not to process insurance appeals. I could accept his reasoning, and knew that I could formulate a strong appeal on my own.

I rebutted it, point-by-point, in a nine page letter with documentation to back up each one of my assertions. My appeal was based on quantifiable fact and written, published data — not on pleas or emotion.

I was denied again, for the same indefensible reason.

But by this time, I’d had enough. The process was so time-consuming and mentally draining, that I chose not to continue with the appeal process.

I felt defeated, knowing that “the system” won; however the relief I felt at finally closing the book on my appeal-process counterbalanced that feeling of defeat. Fortunately, during this time I had found an alternate product that made me equally, if not more, happy.

Next time, I may not have that alternative. That is why I am telling this story.

Doctors are trained to prescribe medical treatments. Insurers aren’t. When insurers contradict the professional, trained opinions of the professionals who provide care, they threaten the health and well-being of their clients. That is not acceptable and the practice has to be stopped.


I’d forgotten how angry and overwhelmed I felt when I had to go through the process last time. You may have followed that scene play out on this blog as I was living it. Ironically, it was with the same two companies, only in different roles, at that time. The similarity between then and now is that both had managed to piss me off.

Diabetes Access Matters. NOW. (Actually, All Access Matters, but that comes too close to a different social discussion that I’m not touching on this blog.)

Damn.

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Posted on May 9, 2016, in Diabetes. Bookmark the permalink. 3 Comments.

  1. I feel lucky to have never had to battle with my insurance. I don’t have UHC, but I have been wearing Medtronic devices for 16 years with no plans to switch. I feel bad for those who are affected by this

    Liked by 1 person

    • For the most part (this story excluded), UHC has been good to me. The only other hiccup I remember is getting a call from my pharma provider (Caremark) telling me that my Bayer strips were off-formulary and that I could save a lot of money by switching to OneTouch (they’d even give me a free meter!). I declined, and then did some investigation and learned I could get the Bayer strips as a medical, rather than pharma, benefit by purchasing thru Edgepark. In the end a relatively minor interaction, but one that could’ve cost me if I didn’t explore all options.

      Liked by 1 person

  2. As I have often told my insurer, “I have a job” and this one does not pay very well. But it is the only job that allows me to live so I have to do it.

    I referred your blog to the TUDiabetes web page for the week of May 9, 2016.

    Like

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