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Battling insurance to get the test strips WE want

Discussion in 'Parents of Children with Type 1' started by Hudson_Rocks, Sep 21, 2011.

  1. Hudson_Rocks

    Hudson_Rocks Approved members

    Apr 21, 2011
    My husband and the boys have Regence BC/BS of Oregon for their insurance. Additionally, the boys have state insurance as a secondary. They are supposed to pick up whatever the primary does not.

    In June the state directed me to a mail order pharmacy, Byram Healthcare, to get strips and pen needles. That order was filled with no problem, a 3 month supply.

    I got a reminder postcard that I could re-order in early September, so I did.

    Didn't hear anything other than one email, so I called last week to see what was up. Was told that BC/BS now bills strips under pharmacy vs DME, and Byram needed BC/BS pharmacy info. Gave them those numbers and was told that all should be fine.

    Got a call this morning saying that BC/BS will not pay for the Freestyle Lite strips, as they are not on their formulary, but they will pay for Bayer Contour strips. We really, really like the Freestyle, and I don't want to have to switch to Bayer. The larger sample size, no light on the meter, larger meter, etc. However....if Regence will not pay for or even accept the prescription, then the secondary insurance won't pay anything. So we would be stuck having to buy his strips, I guess. Their insurance has a $3500 (up from $500) prescription deductible. Yeah.

    So I've downloaded an appeal form from the insurance site, but I don't know how much luck I'll have. I just find this SO frustrating. Anyone ever had any luck appealing for something like this?

    PS -- I was just looking up some things, and I see that the Bayer USB meter has a lighted strip port, and of course uses the Contour strips. Hm. Does anyone use that meter?
  2. Caldercup

    Caldercup Approved members

    Oct 8, 2008
    In our case (which could be different based on the different insurance companies, etc), we could get a "rejected" item passed by having the endo team pre-authorize it.

    For example, my son has a Ping and that uses One-Touch strips which aren't on our insurance's formulary. Our CRNP just sends a pre-auth form with the prescription and the insurance accepts that.

    I'd check with your endo team to see if there is anything they can do for you.

    Good luck!
  3. BittysMom

    BittysMom Approved members

    Aug 21, 2011
    Our Endo had given us freestyle meters for all the reasons you listed. Then our insurance also declined to pay for the strips. I still have the meters, but we use a Onetouch Ultra that the insurance will pay for. I've had it in the back of my mind to try again. The sample size needed is so much smaller- and so is the meter. Good luck.
  4. hdm42

    hdm42 Approved members

    May 1, 2008
    I agree with Eileen. Talk to your endo's office and see if they can override / appeal / pre-authorize the strips you want. Often it's just a matter of filling out the right forms and getting the doc's signature.
  5. zoomom456

    zoomom456 Approved members

    Jan 19, 2011
    Hi Tami,

    I agree with the others, call your endo and see what they can do for you.

    Have you looked at the formulary to see if any other meter/test strips are covered?
    Our insurance is BCBS TN - they will cover Accuchek and Bayer products. They also have these on step therapy meaning we must try these products before they will override and let us use something else. Anything els will always be at the highest copay.

    Right now we use the Bayer Contour USB for William and for the most part we like it. It has a light, but not as bright or convenient as the Freestyle's. The USB takes a very small sample of blood 0.3 microliters and the test strips "suck up" the blood very quickly. I almost never get errors, I think I had 3 since we started mid May. I LOVE the USB connection to my computer and being able to upload Williams numbers. Really, uploads are lickety split and done. I love that the battery is rechargeable, I can plug the meter into a wall charger or it will charge with the usb cable connected to my computer. The usb also can mark beore and after meal tests, as well as sick days etc. HIs meter averages are in line with his a1c, so I think accuracy is ok. We used One touch previously and the averages were always higher than what his a1c indicated.

    The one big con to the USB, for me, is the Glucofacts software. William uses a pump so I like to see hour by hour results that I cannot get with Glucofacts.
    The program only allows up to 5 customized time periods. So I will print the logbook, enter the numbers into EZ manager and get my info that way. However, if William were on MDI, the glucofacts software would work better for us. If you would like a sample I can email a copy. Just PM me:)

    Edit - the sample size is 0.6 not 0.3, I apologize for my mix up
    Last edited: Sep 21, 2011
  6. Jillian06

    Jillian06 Approved members

    Apr 18, 2011
    Could it be that FreeStyle strips are at a higher tier? You could probably get them at a higher co-pay rate. If that is possible, register with the FreeStyle promise program and they will help with the co-pay issue.

    We get $50 reimbursement for a 3 months mail order supply.
  7. Michelle'sMom

    Michelle'sMom Approved members

    Aug 21, 2009
    We have BCBS & received a notice last fall that if we wanted to continue using OT strips (with the Ping meter/remote) we would have to pay the highest copay AND the difference in price between the preferred brand & OT. We had already decided to switch to the Contour USB anway, & I really hated the OT, so we didn't fight it. We love the Contour USB. I don't use EZManager anyway, so the Glucofacts software works great. I would rather have more than 5 time periods available but the color coded BGs make spotting trends so much easier. In the year we've been using it, our avgs have been right with our A1Cs.
  8. Christopher

    Christopher Approved members

    Nov 20, 2007
    I was recently on the phone with Caremark/BCBS regarding an order that I never received. The person on the phone told me the delay was because of the price of the test strips. He went on to say that they are very expensive and did I know of any other ones I could use. I told him that I have been ordering these strips for the last 4 years and it had never been an issue. He finally said he would agree to send me the strips (gee, thanks!) but that I needed to look into this and try and find a cheaper test strip to use. After biting my tongue, I just said thank you and hung up. So we shall see what happens on future orders. I am not planning on changing strips unless they absolutely force me to.
  9. Hudson_Rocks

    Hudson_Rocks Approved members

    Apr 21, 2011
    Some people, huh?

    Thanks to all for the suggestions/advice! I think I will just forgo this battle, maybe :p I was looking on their lists last night, and the stupid thing is there is only about $10 price difference b/t the Bayer and the Freestyle strips. I guess $10 adds up if you've got lots of people you're paying for, but I expected like $50 or something.
  10. CassiesMama

    CassiesMama Approved members

    Jan 17, 2010
    just a heads up if you get the contour usb it does have a light on it for those night time checks and the sample is not really that bad with contour. The ones I hate are the one touch but my daughter likes that it goes with her pumps meter so we use one touch now. What I would give to go back to contour.

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