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Over the past 3 months, how much time would you estimate you have spent working through T1D prescription-related issues with pharmacies, insurance companies, durable medical equipment distributors, T1D device companies, health care providers, etc.?
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Eight times a year I have to spend more than eight hours to fix errors on the part of my mail order pharmacy and DME supplier. My endo doesn’t keep track of when prescriptions expire or need refills so add another couple hours a year building a to-do list for the doc. I’m ready to start billing for my time.
I have a good system at the moment, but I spent hours/days setting it up a couple of years ago.
I picked over 8 hours, but hopefully that’s because my diagnosis was so recent (end of 2021) so all through 2022 I had lots to learn. Coverage for insulin has never been a problem, but CGMs sent me through a loop because they were only a DME benefit, not a pharmacy benefit. It took 5 different phone calls to insurance reps for someone to finally tell me that outright, then another call and forms filled out to get reimbursed for the money I’d spent at the pharmacy. Then when I realized I was spending more anyway by getting them through DME, my policy changed for the new year and they’re a pharm benefit now, so all that runaround feels arbitrary now.
Nevertheless, non-diabetic people assure me that this is a great insurance policy, so I guess I’m married to my job now. Even though it was only meant to be a part-time gig to pay grad-school tuition.
I switched to Medicare as of Jan 1, 2023, so extensive hours have been and still are devoted to this adjustment.
One of the most unnecessary and frustrating parts of being a type 1 diabetic is all the stress and time involved with insurance companies, pharmacies, durable medical equipment distributers and their need to always contact physicians.
Switching to Medicare has created (seemingly) endless hours and day making this transition with all things diabetes related. We’re still in the midst of making this ‘delightful’ change.
This week we learned that Medicare covers Either CGM stuff OR glucose test strips. Thank goodness that God is sovereign over all these details. He helps me walk through these challenges without despair.
Seriously depends on when you ask. The past 3 months have only been an hour or two, but if you’d asked this same question last September it would’ve been over 8 as I dealt with the annual “Yes I need a Dexcom and Omnipod again” red tape with my insurance/providers/doctor’s office. I am counting the time on hold as well, but still – pretty ridiculous that insurance thinks Type 1 is going to magically go away just because it’s been a year. I wish!
I expect that we’ve all had that feeling about how stupid payers can be when it comes to T1D.
I said 5 to 6 hours, with maybe 20min. of that time ordering G6 sensors and tSlim supplies. The remaining time was finding Novolog I could afford.
The last 3 months have been filled with frustrating phone calls now that I switched back to traditional Medicare from a Medicare Advantage plan. I have been fighting to get strips authorized in addition to CGM- they did not authorize them because I had no proof that I had a meter!! Crazy making! I had to write an appeal letter in order to get them, but finally got it worked out. I also had some pump replacement issues, trouble getting insulin, etc.
only once did I need to be advised. Rec’vd a steriod shot for frozen shoulder and had to set my pump to 400% and supplement with direct injections for two weeks. As it slowly left my body I had to slowly reduce the insulin. Complete PITA!! Orthepedics know nothing about insulin/diabetic complications with steriods. Excuse my spelling in a hurry
Normally, no time spent but I changed insulins so I wanted to verify everything with my insurance company before asking my endocrinologist to write a new script.
How do you like the new insulin? Would you mind sharing what it is and why you switched?
It was minimal time to coordinate refills and changes to a medication that the insurance requested.
Significantly less time since I switched from Byram to ADS. It has made a world of difference and saved so many headaches!!
Amy Jo, I left Byram, too! Even had to file a complaint with BBB which sped up the resolution process, at least.
I answered “No time,” but I live in France, where we have a single provider. I receive a prescription from my doctor and go to the pharmacy monthly to have it filled. (Pump peripherals are provided by a separate supplier.) “Appeals” do not exist here since the doctor will only prescribe medicines that are reimbursed. And no, I have never needed a treatment that wasn’t covered.
Most of Europe has the right idea! Is it a good health system for you overall? The US may be too large to implement a national system, but that doesn’t hold states back (as long as there is federal money to help).
Much too much time! Part of it, I know, is my own fault, for not keeping anxiety at bay when I have to sort out which plan will work best, annually. But it is something I dread, every single year. When I call to get some help understanding, the people are almost always very nice, but I have had times when the information was incorrect or not explained clearly. I usually commiserate with the person on the phone for having such an annoying system, and agreement seems to rule the day. But I never chose to make sorting out insurance management a career!
I said 8+ and the reason, as for so many others, can be summed up in a phrase: transitioning to Medicare.
Oh man! You’re so right, William! Read my comment above so you can be prepared for next January!
Just spent an hour and a half on the phone with insurance the other day trying to switch to Dash pods and nothing was accomplished….
Before my last tandem order I’d say zero time, it’s all auto refill. But the lady processed my insurance wrong and it was a nightmare. Clerical error on her part and I had to talk to someone completely different to get it fixed and the right insurance run.
The beginning of the year is always a bit iffy when you’re on Medicare. Even though I’ve already paid my annual deductible, my pharmacy can’t see that, so I must wait until it shows up on my Medicare account before I order new insulin. I always try to have plenty of insulin on hand at the end of December so it’s not an issue. The organization I get my pump equipment from has a lot they must do because of Medicare, as well, and that can get time consuming. All-in-all, I’m lucky to have the time, energy and patience to deal with it, and I know up front these time-consuming moments are to be expected. If I wasn’t retired, it’d be more of an issue.
PUMP USERS: Just in case nobody has told you, if you use a pump, Insulin is considered durable medical equipment, which can save a lot of money, even with the new price cap
I selected 6 hours.
So far, I have spent 6 weeks trying to get a new pump.
I decided to look for a new pump in mid-December as my 770G warranty expired on January 3. I wanted to go hoseless with the Omnipod and the Dexcom 6.
I contacted Dexcom and they sent me to the medical distribution company ASPN, and they could do the Omnipod but only with pharmacy part D with the Dexcom 6 sensor on DME
My part D pharmacy plan had Omnipod as tier 6. $155.56 co pay and $150/month.
The omnypod is not available as DME.
I called INSULET the mfgr of omnipod. They told me they only supply via pharmacy plan to get more T2d’s to sign up.
Verses 100% DME coverage, part D coverage that was a non-starter.
I contacted another supply company CCSmed. They could do both Dexcom 6 and tslim x2.
Ineeded a Endo visit to get the notes and Rx. I had my Endo visit on Jan 20.
Still waiting for CVSmed. Been waiting for 5 weeks now.
Just called CCSmed and they got the endo notes and Rx but Medicare wanted to know who paid for my 770G 4 years ago. Fortunately, that was private/company.
My new pump should now ship tomorrow. Finally.
Most of the 3-4 hours is way ting on a phone
Medicare, Byram, & my diabetes team seen to work smoothly together, but I’m not on a pump, just Dexcom and MDI of glargine and lispro and One Touch meter.
Never had a problem. However, my Endo’s office forgot to use the Medicare Part “B” numeric code once and I had to wait a day. WOW, no big deal.
I’ve had very few issues with DME or insulin supplies. About once a year, I have an issue where the mail order pharmacy says they sent a fax and the doctor says they never received it, but it’s infrequent.
I’m on Medicare. I spend hours on the phone getting prescriptions covered and delivered on time.
I have figured out what I need to do to get my diabetes supplies (insulin, test strips, and pump supplies) with the least hassle and in a way that makes sense. So this quarter, I’ve spent only an hour or so AT MOST dealing with issues related to my supplies. In the past, I’ve spent multiple hours (more than 2) when things have gone awry. It’s on me to determine when to reorder if I am not getting supplies on a refillable schedule. I keep a close watch on my pumps, my strips, and my insulin to prevent problems. I now can and have to get my 3 month supply of insulin from my local pharmacy, under my insurance plan, and that allows me to NOT get a large styrofoam container that CAN NOT be recycled. I refuse as many containers as possible that can not be recycled.