Tuesday, July 13, 2010

Another new kind of fine . . .

Thank you all for you words of encouragement about our insurance situation.  I know we will be fine. 
Insurance for Me, Jim and Emma is a done deal.  Sophie and Nate are another story.  I have been stockpiling test strips and insulin as best I can and I will get another 3-month supply before the coverage ends so we should be ok for a while.  The hard part is that it looks like we will have to take Nate off of the OmniPod.  If we have to pick our expenses --- Insulin is his life so we will have to have that! Test strips are our next priority so pumping will have to wait.  Plus, Sophie's expenses are not exactly light on the pocketbook.  She has a daily maintenance medicine that she has to take 3 times per day and if things don't get a lot better we may have to move on to a very expensive treatment plan for her. 

I am in a good place right now.  I'm not stressing or freaking out (too much) but I am very sad that we will have to stop pumping (podding).  We fought so hard to get Nate on the OmniPod and goodness knows we have worked our tails off getting basals sets, ratios figured out, and correction factors correct!!  Going back to shots may kill me (oh yea and I'm sure Nate won't like it too much either!).

Don't even get me started about being without the DexCom ---- no pump and no Dex.  I will feel like I am stepping back into the dark ages!!  --- The last statement in  no way implies that people that choose not to pump or use a CGM are living in the 'dark ages' --- it is just how I will feel after having what has become such luxuries for us.  :)  I've become quite spoiled!

There are options out there (surely there are!) but the problem is even if we get Nate and Soph on a plan they exclude all expenses of their preexisting condition for at least a year!  It is a frustrating system but it is what it is and like I said I am not going to let this get me down.  We will get through this and be just fine --- just another new kind of fine! 

The good news is we still have our 'beep-beep' (Nate's name for his PDM) and pods for now so I am going to enjoy the heck out of them while I can!!


Adrienne said...

Are y'all going to be at the Kick-Off Dinner next week? I'm pretty sure we have some extra Glucagon kits around, I'll check the dates on them to be sure they're good - but I'll happily share! I'm sorry to hear about these changes, it's so frustrating! I can probably also help with the Multiclix, that's what we use as well. Stay Strong Mama!

Lora said...

I thought as long as you didn't let your coverage lapse... they couldn't deny preexisting treatment. What a load of POOOOOOOOOP!!

I am shaking my head in disbelief!! Stupid system!

Joanne said...

Oh Laura... that just SUCKS! Have you called Omnipod to see if they have a program to help out? I always see that on commercials for drugs (that little "if you are unable to afford your medication, said company may be able to help" disclaimer). I'm sure you've already thought of that, but I thought I'd throw it out there.

I'm so sorry, I hate that you're having to make decisions like this.

phonelady said...

Laura I have been going through this for the last five yrs since I lost my insurance with bcbs which was wonderful until they got bought out which stunk . Yep shots aint great but what else can you do ? and those programs are a bunch of hooey too they have way too many restrictions on those . Oh no they can deny anybody for any reason in this country cause that is how the insurance companys work . I have been denied so many times I cannot tell you . sometimes I think they wish we would all just die and only healthy people had insurance you know . I so feel you and what you are going through . Im just tired of having to pay for it all out of pocket . I am sending prayers and good thoughts your way .

Cdejulius said...

It would be hard to take a step back but your sweet positive attitude always makes me proud. As your Great Grandma used to say "when God closes a door, He opens a window" . . .Am sure such will be the case here . . . That Omnipod sure makes it easier for me to give a little assistance with Nate!! Even a GaGa can use it! :)

Just wanted to send some HUGS your way! Love you!

Jessica said...

I can't remember if you signed up for the freestyle program, but that would reduce the cost for strips- and I've heard costco or sam's club has the best prices if you're buying them uncovered. We have a costco membership if you don't. And please know that we will save any extra pods we have for Nate so he can keep going for as long as possible. The PDM part is covered already, right?

What medication is Sophie taking? Maybe Justin knows of a program or something... I can ask.

Penny said...

I am so sorry Laura. Maybe there are other avenues to explore - have you called your state's Medicaid office that insures kids with disabilities? Or your state Health Insurance Dept to see if they can help you? There might be other options. I know how you love the Pod and I am sad to see you leave it. My thoughts are with you hon. Anything you ever need, you just give me shout out, you know where to find me!

Meri said...

Sucky Sucky Sucky! But you are handling it all with style and grace. If there is a way, you'll find it. I believe in miracles...I hope one comes through for you soon! Love ya!

Ok Lady. Here's what I need. I want you to send me the list of supplies you use. I'll do what I can. I may have a little "magic" up my sleeve!!

Pam said...

Diabetes sucks. And insurance sucks. And stress sucks. It is an absolute crime that an insurance company has the right to deny a CHILD coverage due to a pre-existing condition. They should be ashamed of themselves.

Sarah said...

As my mom said to me "CALL THE INSURANCE COMMISSiONER!" She first said to tell the insurance company that you're calling the insurance commissioner and then she said to write a letter to the insurance commissioner and send the copy to the insurance co. I kid you not we've gotten a few quick replies once I stated that I'd be making some calls.
I have been baffled by the insurance co's abilities to deny/charge for specific items. I am shocked that they wouldn't cover current medications. My last thought is that there has to be somewhere in your area the would help. Where in TX are you? I used to live in Houston and have a few connections out there still in the med world....let me know if you don't mind me asking a few people if they're able to help.
I just think this is wrong despite the fact that you're handling it with such grace, it's still wrong.

Amanda said...

I am so sorry you have to go through all this. I was just talking to my uncle yesterday who has Type 1 and he has been uninsured for the last 6 months. He does what you have been doing - stockpiles and he also uses his pump sites and his sensor for his CGM for longer than he is supposed to.

I get this newsletter from the Crohn's and Colitis Foundation of America and they had a blurb about insurance and pre-existing conditions...I'll copy it here.

The U.S. Department of Health and Human Services (HHS) has recently announced the establishment of a new Pre-Existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.

Some states have requested that the U.S. Department of Health and Human Services run their pre-existing condition insurance plan. Other states have requested that they run the program themselves. For more information about how the plan is being administered where you live, please visit HHS’s new consumer website, www.HealthCare.gov.

For more information about insurance and healthcare reform, please see our FAQ about Healthcare Reform or call our IRC at 888.694.8872.

Good luck!

Jessica is right. Freestyle offers a discount card that reduces the cost of strips by about $50/month, and in our area, Sam's Club is the cheapest (even cheaper than Costco). We pay out of pocket for everything, so we take advantage of that Freestyle discount and Sam's Club prices!

BTW, if you find an organization with a group health plan, Nate and Sophie's pre-existing conditions may not matter. Their expenses may not be excluded for a year. With our plan, Jack was covered from the get-go.

Good luck with everything! Your attitude is awesome! :)

Jen said...

I somehow missed your last post Laura and was completely shocked when I read this one. Our current state of affairs for health care is just appalling. I am so sorry you are having to go through all this (as if you needed one more thing). You are a very smart, resourceful woman and I have no doubt you will find a good solution - maybe even one that will allow Nate to stay on the pump. You have worked so hard to for that Laura I just cannot believe you would have to give it up! Keep fighting and researching! Best of luck to you friend and big, big hugs.

I'm so sorry you're having to deal with insurance coverage on top of everything else. We had Cobra for the first part of this year, while my husband was looking for a new job. I know that under the new legislation, we would have been eligible to extend the initial period of coverage. I don't know if you could qualify for that...Like Jessica, we'll save our extra supplies (right now I have lots of extra ketone meter test strips) and send them to you. Just shoot me an email with your address. Don't hesitate to let me know what you're running low on. I'm here to help!! Best wishes

Hey, Laura. We've ended up with a mish-mash of supplies since switching back to MDI's, including an entire 3-month supply of Pods sitting unopened in the dining room (Insulet won't take them back), test strips, and Humalog. Shoot me a note if you need anything...we'll send whatever we can spare. - Mo

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Just a Mom

I am NOT a doctor, nor do I play one on this blog.

I AM a wife.
I AM the mom of 3 wonderful children.
I AM my son's pancreas.

The information provided on this blog is from our personal experiences with Type 1 diabetes. Because something works for us does not mean it will work for you.

Please consult your doctor if you have any questions or concerns about your health care options.

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