Jumping Through Hoops
A glucagon kit is cheaper than an ambulance ride, yet insurance coverage doesnt always agree.
By Scott Johnson
May 2009 — Living with diabetes means that we need to plan carefully when traveling. We need to plan even more carefully when doing things like camping, which keep us away from civilization for a while. Every year, my friend Molly, with her diabetes service dog, Dixie, and a small group of their friends go camping and canoeing in the Boundary Waters. They are out in the wilderness for up to two weeks at a time.
The Boundary Waters Canoe Area is a very popular retreat in Northern Minnesota. Congress protected this wilderness area in 1978 against logging, mining, and most motorized vehicles. More than 200,000 people visit the area annually, making it the most visited wilderness in the United States.
Molly has lived with diabetes for a long time, and knowing that diabetes deals us some tricky situations sometimes, she does some impressive planning to ensure that her camping trip doesn't come to an abrupt end because of it.
One of the many things that she packs is glucagon kit. Glucagon is a hormone that triggers the liver to release stored glucose. A glucagon kit is a syringe pre-loaded with a fluid that gets mixed into a vial of powder, and then injected. It is typically only used in emergencies, and only when a person with diabetes is unconscious or otherwise unable to treat a low blood sugar by eating or drinking. For someone who has passed out because of a low blood sugar, a glucagon kit is the only alternative to an ambulance.
A glucagon kit is a prescription item, and they do have expiration dates. Most of us living with diabetes would do well to make sure we have at least one, and to make sure it has not expired. In preparation for her summer trip, Molly gets new prescriptions for a few glucagon kits, planning to distribute them into different canoes and bags in case they lose some gear (a canoe capsizing for example). Last year she ran into trouble with her insurance company providing coverage for them. With each kit costing over $100 retail, getting her insurance company to cover these (as they had every year in the past) was a big deal!
Her insurance company refused to cover the glucagon, saying that it was a "diagnostic aid" for something totally unrelated to diabetes and therefore not necessary. Molly spent a lot of time on the telephone with her insurance company, who directed her back to her doctor's office for additional documentation. She was confused! This had never been an issue before! What the heck was causing so much trouble all of a sudden? At this point Molly just needed the glucagon. She was a few weeks away from her departure date when she started working on a simple prescription refill. Who could have anticipated all of this trouble?
Her doctor supplied all of the requested documentation and exemptions, but her request for coverage was again denied. Spending even more time on the telephone she learned (through much anxiety and worry) that although glucagon is primarily used for treating low blood sugars, it is also sometimes used as a diagnostic aid for radiological examination of the stomach, duodenum, small bowel, and colon. Why the insurance company locked in on this particular use, even though they had clear indications that this was for treating low blood sugars, is a mystery to me. Molly's doctor even sent another exemption letter clarifying the use in Molly's case, but it did not help.
How could an insurance company possibly be so "stuck" on denying such a low cost item? That seems especially ridiculous when compared to the cost of an airlift rescue in the wilderness of the Boundary Waters!
Because she ran out of time, Molly ended up taking expired kits with her on her vacation, and thankfully didn't need to use them. She found out much later (November) that there was some coding error somewhere, which was what caused so many problems.
Molly's story is just one fine example of what I call the "hoop theory." We are often made to jump through extra hoops to get what we need, and sometimes, even after jumping through so many hoops, we are still thwarted. These hoops are not something that any of us ask for. Our days are already too busy doing all of the things diabetes demands in addition to the normal challenges life throws at us.
Looking hard enough, I suppose there are some good reasons for some of the hoops (but only some!). But Lord knows these institutions could make it easier for us to get through these hoops and on to taking care of ourselves. I don't know about you, but my life is plenty busy enough without having to deal with all of this "extra" stuff.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
Mustard Sauce Cajun Chicken Soup Beef Filets with Vegetables Homemade Orange Sherbet Vegetable Pita Thai Broccoli Salad Braised Pork Chops with Orange Mustard Sauce Roasted Vegetable Dip with Baked Pita Crisps Nachos de Mer Collard Greens
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...