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Insurance Company trying to limit test strips

Discussion in 'Parents of Children with Type 1' started by NicksMother, Feb 5, 2010.

  1. NicksMother

    NicksMother Approved members

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    After almost 2 years and no problems with our insurance, I got a letter today from our supplier telling me we can only get 100 strips per month. In order to get more, we have to log every test for 30 days on their form and they will decide if we need more strips. I called the supplier to find out what was going on and was told that as of the first of the year, our insurance in now following medicare guidelines for supplies.

    The log they provide doesn't even give enough space to record all the test results in a typical day. It's only got 5 columns: Breakfast, Lunch, Dinner, Bedtime, & Other. I don't know what we're supposed to do on days where you have multiple checks for lows, sports practice, extra snacks/food.

    It's not like we are receiving an excessive amount of strips each month. When our script need filled out again in January, I told the CDE she could lower the amount a little because we were getting more then we need which was 200 a month. But really, how in the world do they expect anyone to maintain control only testing 3 times per day?
     
  2. Connie(BC)Type 1

    Connie(BC)Type 1 Approved members

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    Because they're idiots!! Remember the rest of the world thinks Type 2, and a lot of them seldom test(Not Sister Beth, she's perfect;))
     
  3. saxmaniac

    saxmaniac Approved members

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    Think like a bureaucrat from their end - they're trying to filter out people who *never* test and can't be bothered to fill out the log, and want to sell the extra strips on Ebay.

    Fill out it, and stuff as many numbers as you possibly can into the "Other" column. Don't use it as your primary log, just think of it like a form to fill out to get what you need.
     
  4. denise3099

    denise3099 Approved members

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    Squeeze all the numbers in there and also download your meter and send a printout with their own form. But I do think they think he's type 2. Make sure his record isn't somehow "coded" incorrectly. 100 strips is absurd!!

    When we consider stock piling supplies we always think in case of emergencies. I never considered hoarding supplies in case my ins cuts me off. I think you should keep the higher script for strips until you have a nice fat supply, b/c you never know if it will take months to argue with them.
     
  5. thebestnest5

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    Have your Endo write a strongly worded letter of medical necessity including the reasons your son needs to test and include that with the form.
     
  6. CDoyle1013

    CDoyle1013 Approved members

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    I also had this problem. I contacted my daughter's doctor and he upped her prescription to include more test strips. I then asked the insurance company if they wanted to defend a lawsuit against them. I got them!
     
  7. momma_fish2007

    momma_fish2007 Approved members

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    That sucks. We used to get away with 100 while honeymooning but then it was like a switch was flipped. They doubled it and now THIS doesn't even seem like enough most months.
     
  8. Our3girls

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    Hello, I am new on here. My daughter was diagnosed Dec. 17th and as you all know life has been crazy adjusting and working. I am so glad I have found this site and have utilized so many of the posts. Anyways on insurance. Ours gave us 200 strips then she went back to school for the first time and had a few lows so the teacher felt more comfortable testing frequently and she also got the stomack flu which all equals lots of strips being used. The dr. requested more and they refused saying they dont cover the One Touch??? So instead they changed the meter to Free Style which we found to always be 50-150 higher than what the one touch read and how she felt. Now our Dr. is trying (for over a week now) to get us back on the One Touch. I am just buying the $trip$. It is worth it to keep he properly monitored. :mad: I do not understand them either.
     
  9. cpm122

    cpm122 Approved members

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    This also happened to us. I dropped off his new script for 300/month. (Hunter is having a lot of lows at school - I think recess/PE is the issue, and he plays competitive soccer.) The pharmacy called and said ins. wouldn't cover more than 150/mo. I asked them what they suggested we do (our pharmacy staff is great). The said tell the dr to contact the ins. company about a "prior authorization". (I'm guessing this means the dr explains the medical necessity and the ins. comp. authorizes the script prior.?.?) Anyway, it worked. It took a few days because dr had to contact ins and do some paperwork then send new script - but we get 300 (and i think its every 20 or 25 days or something). Maybe your dr can do the same.
     
  10. shanna

    shanna Approved members

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    we've been going through the same thing this week. They cut us down to 100 strips and i got mad. cant control with that amount. so i went straight to the doctor. they were able to call in a pre-authorization for more strips. plus they provided sample test strips from there office to get us by.
     
  11. Jessicas mom

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    Test Strip genius working at the insurance company

    We just had the same problem. My daughter was in novalog and lantus so we were testing about 5-6 times a day. When we put her on the pump on January 21st I was told to test her every 3 hours around the clock. The amount of test strips we were getting of course changed. Since our insurance company obviously knew that we were new to the pump I figured they would be able to figure out that we would need additional test strips. A week after putting her on the pump I attempted to get more and was told that I couldn't have them because we had already used our allotted amount. I contacted Children's Hospital and told them and they got me in touch with Home Health Care. I called them on a Monday and Tuesday night not only did I get the test strips I needed but they were delivered by a courier to my house. I don't know if your hospital has something like that or not but it is wonderful. They do not supply insulin but they do supply lancets, strips and syringes.
     
  12. Gracie'sMom

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    I think it is so stupid that parents of type I children need to fight for this. It is a MINIMUM to test 4 x/day. That is no lows, no nighttime checks, no errored strips (don't even get me started on that one). That would be 120/day without one low for the month. They are kids. We do not want to be sticking needles in them!!! We got 300 for January and just made it to our next fill!!!! And we had to jump thru hoops to get those 300. Just FYI, the person I called at the insurance company told me the policy limited us to 100 per month, I asked to speak to her supervisor and she read the script and said the other lady was wrong, that it was based on the # of times the Dr. wrote down she should test, which was 10x/day, so she put it thru for 300.
     
  13. Nancy in VA

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    These refusals are pretty standard as a cost-cutting measure for the insurance company. They have standard formularies that they follow until they are asked to deviate.

    Every time I have called for a variance, we've gotten it. Sometimes I've had to do it. Other times the Dr has had to call, but they always get approved when provided with justification.

    Shoot, our policy says you can only have 3 "educational events" paid for each year. Emma was diagnosed AND had pump start in the same year, and we had about 6 "educational events". And, every appointment we schedule just with the nurse for a CGMS trial, CGMS start, etc, is called an educational event, so we have gone over 3 each year.

    I called and asked for an override. They asked if I wanted to appeal a rejection. I told them no, I don't have the rejection yet, but I want approval for these additional events before they are ever submitted, so I don't have to deal with a denial and fighting the denial. I got approval and all were covered.
     
  14. Toni

    Toni Banned

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    Your endo will have to override the insurance company. Endo can prescribe as many strips as necessary. You may have to get a case manager. But mainly, you need a "Preauthorization code" or number. Insurance Co., must grant endo's script, give you the code, write it down and refer to it any time you order strips. If endo does not want to bother with this (it can be a bit of a pain), get an endo who will.
     
  15. GAmom

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    Ours does this too, every few months we have to fight them again. Sometimes it is every month. Why? there has been no cure since last month, so why do I have to keep going through this fight???? Any one else have this?
     
  16. Kalebsmom

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    Nancy, do you have Cigna? They told us Kaleb could only have three as well. I ended up having to talk to the VP of Cigna to get everything figured out.

    Our insurance only wants him to have 100 strips a month, but his endo fought it for us and now we get 300 no problem.
     
  17. deafmack

    deafmack Approved members

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    I am getting the same problem at the pharmacy where I pick up my supplies. The "diabetes police" have taken up residence. Yuck :eek:
    If you want to know that is the medicare policy. one strip a day if you don't use insulin and 3 strips a day if you do. The reason for this policy is not because they care about the patient but to prevent the sale of test strips on the black market. This policy was made not to help the patient but to save money. The policy just doesn't make sense and I doubt it saves money.
     
  18. Toni

    Toni Banned

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    In order for insurance to keep covering the strips (they keep bringing up the issue), the endo's prescription is now worded like this. What I did was ask the insurance company what they needed on the script to cover it. So you will have to ask your own insurance company. She is in puberty, erratic evenings, nights, so we have an unusually high number of strips. Insurance Co will only approve 6 per day.

    On each script we have endo write:
    "Test up to 15 times per day. Freestyle test strips 100s; Quantity 15 boxes/90 day supply."

    There is a prior authorization on file for her. Authorization number 1111111.

    We needed to be very specific. But the authorization info was key.
     
  19. RosemaryCinNJ

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    Have endo write the ins co you deal with or even call them up to tell them you do in fact use a lot of test strips when dealing with a type 1 child.. Insurance companies are nothing but bullies so you have to stand your ground and fight back...kwim? They tried this with me too in the beginning when Amanda was first diagnosed with syringes and strips!! Your endo can help you here...Good luck!!
     

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