15 Comments
Based on your experiences with customer service representatives from insurance companies, do you feel that they understand the needs of people with T1D?
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Having used 11 different medical insurance companies over the years, I have NEVER had a customer service representative or agent that understood the need of a person with T1D. Some would listen and try and understand. Often I would ask to transfer to a supervisor, they didn’t understand either, but at least they had more decision making ability.
My health insurance is provided through an HMO, so the providers and insurance company are the same. I do not have to deal with two separate entities.
If you get a customer service person who is uninformed about people with T1D, ask for their supervisor or kindly ask for someone who knows about T1D. This has helped me in the past phone calls and if you ask for a supervisor, the agent has to transfer the call.
When I call BCBS, the representative may not know about T1D, but the reps at the Kansas City number are extremely helpful. They will 3-way call the device providers when I can’t explain something. I have never felt the need to ask for a supervisor.
Sometimes you get lucky and they are T1 also. It was nice when I was on an Animas Pump as most of the Reps were T1 also but that didn’t always help with Insurance.
Has anyone else ever tried to talk to CMS? I get nothing but “those are our rules”.
They don’t, never had and given their business model is to reduce costs irrespective of the patient impact for as long as they can get away with it. I don’t think that situation will change unless the industry itself changes. Which would need to come from somewhere other than the insurance industry. This may be viewed as a being overly negative, however I’ve been a Type 1 diabetic for 40+ years and I have not seen a lot of change other than in technology to manage Type 1 diabetes. The technology and processes used have dramatically improved.
I’ve found since being on Medicare & a Medicare Advantage Plan for a year now, that customer service representatives have to have a printed out script they must follow. It wasn’t until I got to the next level that I was told that everything my endocrinologist & I did to get my insulin wasn’t necessary because it goes through Part B and not Part D. Which I explained to the first line people, who kept repeating the exact same words over & over.
I have had the same issues as Christine when calling Medicare. The script is their protocol.
I have never had a representative who understood my T1 needs. It got much worse when I moved to Medicare from my employer provided insurance. It has been a nightmare. And even if I do get a somewhat clear answer after hours, days or months of time and effort on my part – coordinating that answer with my dr and the pharmacy or supplier is another nightmare. It is one of the worst struggles in life. It drains me physically mentally and emotionally.
I can see I am very fortunate. My employee insurance is excellent. I pay nothing for insulin currently and when I did I paid $90 for a 3 month supply. I pay nothing for strips. Just pay for pump supplies. However, I am going to Medicare in two years. Yikes!
I answered No, but it does depend on whether I’m talking tothe major medical insurance company or the Pharmacy Benefits Manager (PBM like CVS Caremark). My major medical insurance reps have been helpful and caring, but knowledge of T1D is limited. CVS Caremark reps and policies lump all diabetics together and do not differentiate between T1D and T2D medical needs. Insurance policies and systems especially with sensors, insulin, test strips (don’t get me started on allowed strips / day) and pump supplies do not seem to accommodate the variance day to day in number of units used. Reordering supplies with (not until mm/dd/yyyy for the 90 days) is limiting if you fall ill and need more insulin for an extended period of time. Pump and Sensor equipment failures also cause issues with reordering. Our doctors have to increase the number of units for 90 days to provide a buffer for these things. Quantity Limits by insurance companies on ANY diabetic need should be against the law. I was told by Caremark as a T1D for 54 years on a Medtronic pump at the time, that the American Diabetes Association made a ‘ruling’ that a diabetic should only test their blood sugar a maximum of 3 times a day, so they wouldn’t fill my doctor’s prescription for 10-12 times/day. We got it straightened out but I honestly think it was because of the Senate hearings on PBMs and insurance companies withholding needed medication. Sad 🙁
I have used CCS for years and they are easy for me to work with for pump supplies. Byram was terrible and I left them when they would not send me my CGMs and now get them at Walgreens. Walgreens has been easy to work with too.
The requirements for being a customer service rep for insurance companies do not include any form of medical training/knowledge. Yes, indeed, they are reading an allowed script from a computer screen on the recorded phone line. They have no power to do anything else. It is deadly dangerous to not be able to get necessary supplies because of the lack of knowledge about T1D. Unfortunately, that same lack of knowledge extends well beyond the insurance companies.
My experience is limited to online conversations, sometimes very good, others moments negative. It is a very hit-and-miss situation, needs major improvement in the area of customer service by suppliers.