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Argh! Insurance no longer covers Ketone Strips

Discussion in 'Parents of Children with Type 1' started by kimmcannally, Aug 13, 2011.

  1. kimmcannally

    kimmcannally Approved members

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    What a pain in the patootie! Because the Precision Xstra ketone strips can be bought over the counter, insurance just quit covering them.
    Know how much Publix quoted me for one box?
    $50!
    Thank God I have 5 boxes left and J hardly ever gets ketones.
    Guess I'll be posting in sale and swap when we finally use up those boxes.
    If I'm not mistaken, BG strips can also be bought over the counter. I didn't put up a fuss about the ketone strips, but by God if they try to quit covering BG strips we are going to go round and round!
     
  2. kgerrick

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    Oh my gosh that a lot of money!! We get dd ketone strips at Wal-Mart over the counter for $6.00. It is there brand called Reli On. That's for 50 strips. If you have a wal-mart around I'd give them a call. Good Luck!:)
     
  3. Michelle'sMom

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    Kristen, I think you're talking about the urine ketone strips? Precision Xtra are blood ketone strips. I WISH they were $6 a box!:cwds:

    Kim, I keep waiting for our insurance to stop covering them too. I do have a small stash, but we know how fast that'll go with an illness.

    The strips for the Nova Max meter seem to be a little cheaper, at least online...around $7 less per box.
     
  4. danismom79

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    Well, when you do run out, let me know. I keep getting our script filled, just to have a couple of boxes, and I always end up sending the rest out because we almost never use them. We get 9 boxes for 3 months.
     
  5. Lisa P.

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    Did you ask a few times, a few different people?
    I've found insurance and pharmacies sometimes don't know what they're talking about with blood ketone strips and sometimes you have to talk to the right person.
    I also had a talk with someone recently who's been dealing with T1 for 25 years, and had to wrangle with insurance companies. She said she will fearlessly pull out the word "discriminate" -- if they try to limit her as if she's a type 2 diabetic, she'll tell them they can't discriminate against her because her needs as a brittle diabetic are different, they need to provide the same level of care for her as for someone with different product needs. (she uses the term brittle, again I think because it's something they can understand).
    So I'd take a run at making the point that Type 1 diabetics can go into DKA with ketones, so being able to monitor blood ketones and get an immediate snapshot is essential for Type 1.
    Last I looked blood ketone strips were $10 each from Precision, OOP. . . :(
     
  6. KellyH

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    (You can get the ketone strips to work if you tell the meter the date is before those strips expire. Set your meter date to a year or two ago.)

    ~ Posted the above from another thread because I didn't realized I could do this. I would definately try calling the insurance company about this ~ UGH just one more thing, right?
     
  7. ecs1516

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    How long are the Precision Ketone strips good past the expire date. I have some old ones too
     
  8. kimmcannally

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    That must be the urine ketone strips, right? We use blood ketone strips, but will go back to urine if we absolutely have to. I hate to take a step "backward" in his care, though. We both love the blood strips.
     
  9. kimmcannally

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    I did not, only talked to one person at pharmacy, one at DME supply and one at BCBS. Maybe I'll give them another call about it. Thanks!
    I'm glad Publix had them for $50, surely that was a box of 10, I don't think they come in a smaller box? Maybe it was with an insurance discount? No, that doesn't make sense, since they refused to cover it at all. I don't know why it was cheaper.
     
  10. Lisa P.

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    I've had folks give me conjectured answers when they didn't know exactly what was going on, they'd kind of make up a "this isn't covered because of this" reason when it was really just that they had never heard of blood ketones strips or whatever. Kind of CYA. Might not be the case here, just kind of quacks like a duck to me.

    If you have insurance, here's how services work.
    There is the retail price (sticker, MSRP, sort of thing) -- so, say, $10 per strip or $400 for a doctor appointment.
    Then there is the "negotiated rate", which is the price the insurance companies pays after negotiating it down. This is easily half the retail. Think of it as "wholesale".
    Then insurance pays its part, you pay your percentage or copay, and that is your final price

    We would get this from pharmacists sometimes, they'd say "insurance paid $50" when insurance hadn't paid a penny, it's just that when you go through insurance you get the negotiated price, not the retail price.

    Don't know if that's what you saw, or how your system works, but it's how it works for us!

    Sorry to be a dog with a bone, I have found so much over the last two years that if you ask 100 people an insurance or billing question you'll get 93 answers. So I'm less than likely to just accept an answer that makes no sense to me. I have had at least $1500 in medical billing errors over the last two years, pure errors, that would not have been caught if I hadn't talked to multiple people. In one case, I was charged for a biopsy I didn't have. I talked to two different offices three different times and got the brush off, finally wrote a letter to the administrator and she called, very apologetic and helpful!

    Good luck, blood ketone strips should definitely be covered, they are a good product!
     
  11. kimmcannally

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    Thanks Lisa. You know I think you might be right - the lady did say that they never covered the strips, and unless the DME was pulling a fast one, they did cover the strips last year. I'll call again on Monday to see if I can get a better answer or start an appeal process.
     
  12. kgerrick

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    Kim and Michelle,

    :eek:Oops that is what I was talking about!! We aren't familiar with blood ketone strips yet. Sorry!!!:eek:

    I think Lisa is absolutely right! Keep calling them. You will get a different person and just push on until you get your point across. Good Luck!!:)
     
  13. Lakeman

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    Hmmm? I suppose my insurance might do the same to me...I guess I will have to refill mine just in case. Which of course will cost the insurance company more. But obviously I am not going to wait around having just enough and then have them deny a refill later.
     
  14. Michelle'sMom

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    For almost a year, we've been getting letters from the insurance on all sorts of things. It started last fall when they decided if we wanted to keep using OT strips (we use the Ping & were using the meter/remote at the time), we would have to pay the highest co-pay plus the difference in contracted price between OT & their preferred brands. Fortunately, my dd had fallen in love with the coolness of the Bayer Contour USB & I was way past my patience limit with OT & the Ping remote. Not a problem to switch.

    Once a month without fail, we get the brochure & packet to switch to mail order through Prime Therapeutics. Unlike some CWDers, we would still have to pay the 3 separate co-pays, so there's no advantage for us to switch.

    Then there were the 2 reminders (May & June) about not getting our quarterly A1C (we skipped our May endo appt because it was scheduled during final exams).

    I'm just waiting for the letters about the ketone strips & Apidra. I've already started preparing my appeals. :(
     
  15. Lisa P.

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    Yeah, there's just no institutional sense anymore in some of these big companies. Lots of penny wise and pound foolish. :(
     
  16. mom24grlz

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    ouch $50! We just got a box of the precision Xtra strips last week. Thankfully they're still being covered. If we had to pay the $50, my husband would tell me to forget it and just get the urine kind. Ashleigh hates that kind, she says it's gross LOL! But we wouldn't be able to afford $50 test strips.
     
  17. Lisa P.

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    Wow, if my insurance thought it could tell me when to do an A1C test it might actually drive me right over the edge I've been balancing on for years. :( How can this even be legal, what right does your insurance have to know when you do and don't do an A1C? Except to know when you did it, so they can PAY for it, which is their only role!? Ugh.

    So sorry.

    To the OP, hope it works out. What a hassle either way!
    :(
     
  18. GaPeach

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    It makes no sense to me at all. Our insurance does not cover the urine or blood ketone strips. So, rather than allow a $15 (urine) to $50 (blood) script, the ins. co faces the potential $2,000+ ER bill due to the lack of ketone testing supplies. Go figure!

    We have to argue for a PA (Prior Authorization) every year for OneTouch strips. The OneTouch Ping is their preferred pump. However, the OneTouch strips are not. Huh?
     
  19. kimmcannally

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    That is absolutely crazy! Beuracracy at work. :confused:
     
  20. kgerrick

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    That's crazy!
    But you can see that sort of thing happening with just about anything! It's too bad!
     

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