Tuesday, April 16, 2013

Insurance Company Math . . . .

I had my endo appointment on Friday.  I’m always nervous about what the labs might reveal, and this time I was extra nervous because we were testing my thyroid.  Luckily that came back fine and there was no evidence of any anti-bodies present that would be hell-bent on thyroid destruction, so that auto-immune bullet has been dodged so far.  My other labs came back fine as well.  In a cruel twist of fate, the fact that my A1C was the lowest it’s ever been wasn’t really good news.  It’s getting into the “too low to be safe, you need to stop having readings in the 40s” range so we did some basal tweaks to tighten up my standard deviation.  Not that my deviation is horrible, but a higher A1C with less lows would be better.

One of the things I was most looking forward to at this appointment was getting a new prescription for test strips so I could officially change meters from OneTouch Ultra Link to my new Bayer Contour Next Link.  Yes, I could have called the office at any time for a new prescription, but I’m lazy I wanted to finish up  my 3 month supply of One Touch strips first so I just waited until my appointment.  And it couldn’t have been easier.  Dr. F asked me where I wanted to fill them, and I picked my local pharmacy so I could use my Contour Choice savings card, which can’t be used with my insurance mail order service.  (At least, that’s what I’ve been told.)  Anyway, I picked my pharmacy, Dr. F typed a few things into his laptop, and zingo, the order was ready and waiting for me!  Fast and easy, right?

Right.  Except . . . . when I got home and opened the package, I found I had gotten 2/3s of my test strips and a nice (ha ha ha) note about insurance coverage.

Yes, that is a cat paw in the bottom left corner.  K.C. loves any papers, even stupid insurance denial ones.  Anyway, I had gone through the “you can't have that many strips” - “but I need that many strips” dance less than a year ago.  Apparently my insurance company is having memory problems or something.  So I called them and explained that I had been approved for a larger amount of test strips, and that a new meter brand didn’t change how often I need to test.  The customer service guy was nice, and “fixed” the problem so when I refill the order from now on I’ll get all of the strips I’m supposed to get.  Good . . . . . but what about the other 1/3 of the order for this month?

According to Cigna, I’m just out those strips.  So basically I’ve paid 100% of my co-pay for 67% of my order, and that’s just the way it is.  I can’t think of any other situation where it’s okay to be charged 100% for only 67% of your goods, but I guess I just don’t understand the tricky insurance company math.  Sure, I got A’s in Accounting at a very good business college, but I guess Cigna has a different accounting system that I’m not privy to.

Don’t get me wrong.  I’m thankful to have insurance.  I’m thankful to get some kind of coverage for the supplies I need to stay healthy.  But really, when I feel like I’m being flim-flammed and given the run- around, I can’t help but feel aggravated.  You’ve been there too, right?


  1. You need to call them back and get an override. They will cover all of the strips, but you will likely need to go over customer service guy's head for the approval. Don't be afraid to ask for the medical director. Your script showing the number requested by the doctor is their verification... Good luck!

  2. Don't you just love it when someone without a medical degree and/or very little knowledge of diabetes can make your health decisions?

  3. Whoa - that is some sketchy math, IMO.

  4. I love your new profile pic! Nice hair cut and pretty spring colors. =)

  5. The pharmacy can back bill the claim for up to 2 weeks, so you should be able to call them and tell them it was approved for the full quantity and get the other box. No promises, but I've been able to do that for people at the pharmacies I've worked in.

    1. Thank you for the info, Niki!! I actually have to stop by today because they only did a partial fill on my lancets and the rest are in stock today so I'll ask them about the rest of the strips. :)

  6. My insurance did that same math a few months ago. Said I was limited on test strips, my doctor called and corrected them, they fixed the next order. The biggest problem I had was that incorrect order was for 150 strips per three months. You know how long those would last. There was a bit of a battle to get my next shipment sent before the three months. Now I laugh.. they send me 18 boxes of 50 strips, when it would be easier to send 9 boxes of 100 strips. I tried explaining that, but they said, "That's not how the prescription was written". Ya it was.. they just changed it. Silly/stupid insurance company.

  7. My question is always, "Okay, great that you'll make it right for me in the end, but why do we always have to do this you-deny-I-call-we-dance-around-until-you-see-it-my-way thing?". It makes me cray-cray.

  8. Love it, StephenS! So true, sadly. My child's script for Novolog was written for 2 bottles per month...because she'll run out before the end of the month. Well, they calculated and one bottle is enough for 25 days ( in their opinion) so it will allow a refill every 25 days. Which means I have to pay 2 co-pays every month instead of one. Ah, well. But, yes, SO thankful for the insurance:)

  9. I have been having a similar problem with my strips. My supplier had been sending me 11 boxes of 50 strips then on last order sent only 6-said Medicare only allowed enough to test 3 times a day even though my Rx called for 6-8 times a day. They already had a log which documented at least 5-6 times a day. I had to send them a new log-they called and are supposed to be sending the balance. Haven't seen them yet!!Supposed to be corrected on next order too-which is due to be shipped on April 22-I don't know how they expect us to test properly aand take care of ourselves when it is a constant battle with these morons who can't keep things straight!!I get really tired of doing EVERYONE else's job!!

  10. glad to hear you have no problems with your thyroid. sorry to hear about the stupid insurance runaround! lucky for me i have 100% coverage, the only downfall is having to pay the 100% up front and then send in the receipts for refund. i'm finally on a system that works out so the money is coming back in when its time to refill.


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