Oh the Game We Play

One day ago I decided I needed to get another set of sensors for my Dexcom, and so the game begins. Why do insurance companies try to play games with our life saving medicines? Well I guess the Decom isn’t really keeping me alive but it helps prevent me from succumbing to the lows that can lead to much worse problems. Car wreck, getting hand stuck in a machine at work, or even as simple as not figuring my insulin right because my sugar is low.

I called 2 days ago to se if I still had a refill left on old Endos prescription. I evidentially had.. Here’s where this gets very weird and made me ask questions. Earlier this year I was talked into trying a pump again and it put me over the yearly out of pocket for my insurance. Sad part is the pump still does not work for me. We spent 2 almost 3 months trying to work things around to get it to stop alarming out (low and high) but nothing worked very well. I gave up on it but didn’t get it returned. That is another story.

Anyhow, I have been getting all my meds and supplies for $0 since then. After I got off the pump I started using the Dexcom again and had to get a set of transmitters. Those thumb sized little marvels of medicine are $1000 a piece and I got 2 of them for free. Well I thought it was going to be free but I ended up paying about $150 for my share. The insurance company gets a discount so they are less than $1000, maybe $990. I don’t know or care really. All my insulins and test strips are being paid 100% since trying the pump.

I get a call yesterday morning from the place supplying me with my Dexcom supplies and they tell me my credit card was declined. Wait, why was it even being used in the first place? I asked the lady why it wasn’t covered 100% by the insurance company. She told me they claimed there was $260 left on my out of pocket to pay. Huh???

I told her that was not right as they had been paying for everything since roughly June or July. She looked closer at my account and at the transmitters I had received months ago. Low and behold, they had listed the same amount, $260 as left on my out of pocket back then. The $1100 I had to cough up for that pump pushed my out of pocket over for the year. Someone who deals with insurance companies all day could not come up with an explanation for this weirdness. She also told me I had a $150 credit on my account.

I asked where that had come from and she told me the money I had paid for the transmitters had been switched to credit as the insurance company had paid the cost in full, after I paid out the co-pay amount so they had given it back as credit. Fine by me but what the hell is going on with my out of pocket costs being out of whack? She looked even closer and found they had done the came thing back then as now. They had showed I still had money to pay for out of pocket yet were paying 100% already back then. Anyone confused because I sure am. The company I was dealing with was very nice and reasonable about all this. She said she would apply my credit to cover the sensor but if, better be when, they pay in full they would return my credit.

Thank you so Diabetic Supply of the Middlelands. You went above and beyond with this issue. As far as Coresource goes, I’m watching you now. Now that I’ve seen one of your tricks I can watch for it next time. I hate playing games but when they are pushed on me, I will figure out the rules and use them to ruffle your feathers. Pluck them straight out if need be. If you are going to waste my time with stupid issues then I feel it only right to follow your example.

P.S. To add to all this confusion, I saw another endo at my then current endocrinologist’s behest to see if she had missed something as to why I was always dropping so low while on the pump. I again, my mistake I guess, thought it would be covered 100% even if not in the “group”. I now own them/her $385 for that visit as the insurance company refused to cover it, at all. Was it not preapproved? I kind of thought they would have checked that out first. I’ve never gotten a good answer to that one looking at my stuff on line. Really need to call about that one. Just another nail in the coffin of trust I had with them.

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