Diabetes Viewpoints

Rest Unassured

By Christel Marchand

If it wasn’t such a comical conversation, I would have cried.

We had a choice of new insurance plans, but very little information with which to make our decision. John knows that I have significantly more experience with handling this sort of morass (and I must admit, I believe he takes pity on the unsuspecting insurance representatives when he says: “Why don’t you handle this?”), so I decided to call the company and explore which plan would be best for me.

For anyone who has diabetes, has a child with diabetes, or, in reality, any person who has a chronic illness, the thought of switching insurance companies can be nerve wracking. What’s covered? What’s not? How much are co-pays, prescriptions, specialist appointments, durable medical equipment? What happens if there is an emergency? Do we have to call the insurance company so that they can determine if an ER visit is necessary? How are billing mistakes handled? Even when you think you understand the policy, you receive a notice that has you on the phone for hours, trying to straighten out a billing issue.

Stress is a part of life. I’ve accepted that. However, undue stress caused by trying to get simple answers to simple questions from an insurance company is unacceptable.

“I’m calling about the prescription benefits and durable medical equipment policy for two medical plans that you offer.”

“I’m sorry. If you are not a member with an active policy, I cannot give you that information.”

“Well, I’m not an active member because I’m trying to choose between two plans that are being offered to us. Once I get the answers to these questions, then we can choose a plan and become active members. I don’t want to choose the wrong policy and find out that certain items aren’t covered.”

“I can’t give you the information. You need to do your own research before you choose your policy.”

I grit my teeth, grimace, and then take a deep breath.

“I am doing my research. I am calling the insurance company directly. That’s you, right? You administer the policy, but you aren’t going to give me information until I am an active member, but I have to choose a policy without information. You do realize that this is circular logic?”

The conversation didn’t improve. It ended without getting the information that I needed, and a search to get a policy booklet from the company that, once received, revealed the answer to one question – and nothing about the other. We chose the policy that I believe will serve me best, but I still have my doubts. I hope that I will never have to test the boundaries of this medical plan.

Even with insurance, we struggle with the financial burden of staying healthy – and alive. In 2005, a Harvard study stated that illness and medical bills were the leading cause of bankruptcy – and the most disturbing statistic was that over 75% of these individuals had medical insurance at the beginning of the “bankrupting illness”.

I am grateful to have medical insurance. For those who do not have medical insurance (and for those who may have medical insurance, but need more assistance), what can you do?

There are patient assistance programs that can help you procure discounted or free prescription drugs, meters, and strips. Most major pharmaceutical companies do offer help to those who need their drugs but cannot afford them. You can also contact your state’s organizations for assistance; these state-run programs may cover doctor’s visits and additional medical help. If you have a medical team already in place, talk with them about any programs that can help with the financial impact that diabetes makes on your wallet.

Disclaimer
dLife's Daily Living columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team to find out what will work best for you.