12.2.16

My Hard-Knock Healthcare Wisdom (Tips on How to Navigate the Exchange)

health-insurance

It was about this time last year when I wrote, Battle To The Death.. My Death That Is, about the countless hours/days/weeks I spent dealing with insurance companies. I want to start by saying that I’m incredibly grateful to finally have medical insurance as someone who has been self-employed most of my adult life, but this recent round(s) of phone calls has me questioning a few things.

I was doing some serious number crunching as to how to get the most “bang (test strips) for my buck“. I’m an intelligent woman, in fact, I’ve taken an insane amount of higher education math courses, but this conundrum wasn’t adding up. I had to change how I was going about the situation. After contacting BCBS(OK) for a 17th time in three days, I framed my questions differently so I could better understand.

Here is the scenario I presented to the pharmacy department of BCBS:

  • CVS = $394 out-of-pocket ($10 co-pay) for a 90 day supply = 300 strips
  • Walgreens = $434. 97 out-of-pocket ($15 co-pay) for a 25 day supply = 200 strips
  • Wal-Mart = $366 out-of-pocket ($10 co-pay) for a 90 day supply = 300 strips
    • No Insurance Needed: ReliOn (Wal-Mart brand) $18 out-of-pocket = 100 strips

She explained CVS used to be a preferred pharmacy, but that would end as of 12/31/16. Walgreens was not a preferred pharmacy in 2016, but will be as of 1/1/17. Wal-Mart has always been a preferred pharmacy and has the lowest co-pay. The kind soul at BCBS also added the number of strips per 30 day prescription is dependent upon the language of the prescription. BINGO!

As a T1D veteran and average soul who lives on a budget, I want to share a few tips that helped me navigate the diabetes prescription dilemma.

Overall Tips:

  • Keep a log of every conversation (date, who you spoke with, items discussed, etc.) I even write down how long I was on the phone.
  • Ask questions. This is your life we’re talking about so no question is dumb or needy.
  • Insist your doctor(s) write the correct prescription. Your co-pay is dependent on the # of days supply. In my case, it was 30 or 90 days, but it wasn’t really that simple and is a WHOLE other post.
  • If you’re a part of the Marketplace, you can contact your carrier and ask for things. Inquire, inquire, inquire… they will not offer up that information unless you ask.

At the end of the day, I’m truly blessed to have never lived without diabetes supplies. With that being said, I’ve remained an MDI so I haven’t dealt with pump or CGM supplies, which is a whole other ballgame.

We’re all in this together so I would LOVE your feedback on how you’ve survived the rocky insurance waters and came out alive. Your input can help someone else who might not have a clue as to how to make it happen. Knowledge is POWER!

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Amber Clour was born and raised in Norman, Oklahoma. 21 days after her eighth birthday, she was rushed to Children’s Hospital where she spent two weeks learning how to live life with Type 1 diabetes. She has embraced the thought of being a #walkingscienceproject and hopes to score an A+ for her efforts to maintain a stable BG while living life to the fullest - whatever that means.

2 thoughts on “My Hard-Knock Healthcare Wisdom (Tips on How to Navigate the Exchange)

  1. As for me, I let my wife do it. Yeah we all need a Sheryl in our life.

    This item has been referred to the TUDiabetes Blog page for the week of November 28, 2016

    PS: That is not true, If Sheryl sees this she will think it funny (I hope).

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