Diabetic Recipes
www.comstock.com
The new insurance kicks in tomorrow. I am a nervous wreck. I keep bolting up in the middle of the night (OK, not bolting, more like pissing and moaning when the baby wakes me and then unable to get back to sleep) with all these thoughts racing thru my brain. I don't think our state is one that excludes prior conditions, but I don't know if that applies if you've had a lapse in coverage. And does a month qualify as a lapse? Am I going to have to jump thru hoops to make sure Olivia's supplies are covered? Will we have to pay out of pocket for a year? Gaaaaaaaaaah! No wonder I'm so freakin' tired all the time.
So tomorrow I get to call the new insurance and talk to them about all this. Fun, fun, fun. I get to see if they cover her endocrinologist (I know they cover her pediatrician) and how many test strips they'll allow. I get to see what their pump coverage is and how many hoops I have to jump thru in order to get her a new one next year. I hate, hate, hate dealing with this crap.
It's maddening. The insurance companies act like they're doing you this huge favour by deigning to talk to you about your coverage. Like I'm not forking over good money for this. Like I'm some sort of beggar. Like they're being magnanimous by "allowing" Olivia to use 10 test strips a day. I hate having to justify that. Don't they realize that by testing so frequently, I can head off highs earlier, thereby saving them thousands and thousands of dollars down the road? Don't they get that testing = fewer complications? Why to they have to make it so freakin' difficult?
I just know I'll get on the phone tomorrow and have an attitude about it before I even speak to anyone. I shouldn't, but years of experience has told me that 9 times out of 10, I have to argue and fight and fax things and call this department and that department and I swear, they're just trying to get me to give up.
Who knows. Maybe tomorrow will be a breeze. Somehow, though, I doubt it.
I think the lapse is 6 weeks. It has been a few years since I was in the danger zone - I just remember I was 2 days away from having to wait a year on the pre-existing conditions.
The other thing I would check is the co-pay on supplies. I found out a YEAR after starting my insurance that if I ordered insulin and strips at the same time it was only subject to one co-pay. And how was I supposed to know that? It was not in any of the paperwork.
Good luck! I know you'll keep us posted!
Disclaimer: I am not a lawyer or an insurance agent; do not take the following in place of legal advice or opinion.
Julia, check the details of the medical plan. That should be disclosed in the plan information, which may also be available online. Those details may tell you to what degree or co-pay diabetes medications and supplies are covered. I did some checking around to see if Massachusetts requires these to be delivered at no cost other than monthly premiums (I have been told that some states require this), but could not find anything.
What I did find, mostly on the Massachusetts Division of Insurance Web site, is that by law, if the insurance policy covers diabetes, it must cover pumps and pump supplies and CDE visits as well as insulin, glucometers, strips, etc. Nothing is said specifically about the degree to which these must be covered, or whether or not an endo must be covered. (MGL c. 175 § 47N for indemnity, c. 176A § 8P; c. 176B § 4S for Blue Cross/Blue Shield; c. 176G § 4H for HMOs.) Which, unfortunately, does not save you that phone call.
OTOH, it appears to me that under Massachusetts' Health Insurance Portability laws, the one-month break should NOT affect Olivia's coverage under the law. (http://www.mass.gov/legis/laws/mgl/176n-2.htm)
If your call to the insurance company does not answer these issues to your satisfaction, you may want to consult with a lawyer and/or have your lawyer write a letter to the insurance agent. (If you don't have a legal plan which covers phone consultation and lawyer letters, check out Prepaid Legal Services. I am both a sales associate and a customer .)
Thank you SO much for that information! I think you saved me a few headaches. :)
Good luck, I hate dealing with insurance too. I think they don't worry about avoiding complications because they assume you'll be on some other insurance by then plus it doesn't affect THIS quarter's profits like paying for test strips does. The business short-sightedness inflicted by the stock market.
Julia: glad I could help some.
Kim: some insurance companies and states are changing their required or provided coverage. My current plan allows me unlimited strips and lancets with a doctor's prescription, without ANY co-pay. My Other Half gets the same, plus he does not have to pay ANYTHING for his metformin extended-release. FWIW, we have United Health Care.