Today is the first day of Diabetes Blog Week. Its founder, Karen Graffeo, proposes: “Let’s kick off Diabetes Blog Week by talking about the diabetes causes and issues that really get us fired up.” For me, fired up often means the long slow burn.
I’m lucky. I have health insurance, and, except for the three months following my college graduation and until I got my first full time professional job, I always have had health insurance. My diabetes diagnosis in 1992 has never, to my knowledge, threatened my access to either health care or coverage although I have certainly done my share of worrying about it.
The complexities of the U.S. health care system, however, means that patients have paperwork to do and phone calls to make to coordinate their care, get referrals, and sort out billing questions. If a patient has a chronic illness like diabetes, the effects of our bureaucratic system is multiplied.
I was reminded of this recently when I got a form letter from the company that handles my prescription benefits. The test strips I use with the glucose meter, which is wirelessly connected to both my insulin pump and continuous glucose monitor, will no longer be covered after July 1. The insurance company is recommending that patients change to another brand of strips, which will be covered at the same level. If I change the strips, I realized, I have to change meters, which means discontinuing the continuous glucose monitor, which means less functionality with my insulin pump.
Alternatively, I imagined that I could stick with the strips I currently use and pay retail for them: $600 for a three month supply as opposed to $80 for a three month supply. That’s $2,080 more per year. If it comes to that, I imagine I’ll drop the CGM and stick with non-invasive home blood glucose testing.
The form letter sat in a pile of mail for at a few weeks. I knew I had to do something. Could I appeal? This morning I called the company that sent me the letter. I learned that, yes, there can be an appeal but (a) my doctor has to do it and (b) he has to wait until July 1, the day the coverage ends. “In the meantime,” the company rep asked me, “Can I process a refill? You’ll at least have three more months of these strips.” I said yes, paying $80 for strips and what feels like a little more time to figure this out.
I will ask my doctor to appeal. I made a note in my calendar to contact him around July 1, but after that the paperwork is up to him. How much of his time and mental energy goes into dealing with issues of insurance and coverage for his patients with diabetes, as compared to interacting with them, listening to the health challenges they face, and advising them in being well and meeting their goals?
Or, if my doctor doesn’t have to make this call himself, how many people in a doctor’s office or clinic or hospital are employed to sort out these insurance matters? Is that cost less than what it would cost for, say, my preferred test strips? Is the total cost less than what it would cost to give all people in the U.S adequate health coverage, including the medications to sustain life and well being?
I have two other medical paperwork matters to figure out this week. I’ll pace myself and confront those, too. During the summer, I’ll have to revisit the as yet unanswered question about my test strip coverage. The overhead to having a chronic illness is prodigious, and I could take a nap just thinking about it. Most days, I’m at my limit with the blood glucose testing, meal planning, exercising, and overall self management. Then there is this other layer.