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Insurance limiting # of strips

Discussion in 'Parents of Children with Type 1' started by rtjlolson, Feb 4, 2011.

  1. rtjlolson

    rtjlolson Approved members

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    We just opened a letter from the insurance company notifying us that as of April 1 they will be limiting our monthly strip order to 200. My son is 8, very active in sports and typically tests 10-12 times a day. This new plan will limit him to testing 6 times a day! At our last appointment the doctor was very pleased with his A1c (6.8). She credited it due to his vigialance in checking his blood sugar throughout the day. Now the insurance company is wanting to limit the # of strips?? Is this common for other's insurance companies? I can't believe they want to discourage people from checking their blood sugar. Any advice?? By the way, we do not plan to let him know this information. We will buy strips at the store if needed. I appreciate your comments in advance.
     
  2. Jeff

    Jeff Founder, CWD

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    Ask your son's doctor to write a letter of medical necessity for the number of strips that you need. Document every low blood sugar -- that is typically effective in getting approval.
     
  3. obtainedmist

    obtainedmist Approved members

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    We did this and we are getting what we need now!
     
  4. Stacey Nagel

    Stacey Nagel Approved members

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    I was just going to say that !! :p
     
  5. Alex's Dad

    Alex's Dad Approved members

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    The same thing is happening to us, the endo told us it was useless to rewrite the prescription or do anything, they will denied it anyways. We were thinking about buying it out of pocket, or buy a very cheap brand to do extra tests.
     
  6. hdm42

    hdm42 Approved members

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    I agree with the others, get your endo involved. They often can appeal it over the phone, but otherwise have them write a letter of medical necessity.
     
  7. rdhead

    rdhead Approved members

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    Depending on who your ins co. is I would ask your endo like the others have stated. During Connor's first 2 months we were going thru strips like crazy. I actually called our ins to see if they could raise the limit. They told me to go thru the endo and to submit it for review that if it was medically necessary that they would adjust it. Good luck.

    Also if you do end up having to pay out of pocket the cheapest we found was the walmart relion brand tester and strips.
     
  8. ashley_lynden

    ashley_lynden Approved members

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    Our insurance doesn't put a limit on the number of strips, but they will charge me extra copays. For every 200 strips I am charged one co-pay. If I get 250 strips or 400 strips it doesn't matter but I can expect to pay double.

    Needless to say, I get our strips through Medtronic now. We have no cap on our DME so it works out better.
     
  9. Beach bum

    Beach bum Approved members

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    Ask your endo to write the scrip to say:
    "test up to 12 times a day" We have this to accomodate for errors, school supply, illness etc. Written this way, it has never been a problem for us.
     
  10. Melissata

    Melissata Approved members

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    That is simply not true. We had to send in a month's worth of bg's showing how much she tests along with the doctors script for 10 times per day. It was approved right away after doing so. With another insurance company I had to appeal it in order to get them. They are simply trying to stop the people from getting way more strips than they use and then selling them on Ebay. Once you show that you actually need that many, no problem. We will probably have to send in the log once a year, but it is worth it to me. They may ask for a letter of medical necessity also, but you shouldn't have to pay out of pocket for something like this. The more people that just go along with it, the more they are going to try to limit them.
     
  11. CaelinsMommy

    CaelinsMommy Approved members

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    Our insurance has a quantity limit of 240 strips each month. The CDE was able to get a quantity override for 300 per month and it was all done within a matter of hours. Ask your endo or cde to contact the insurance company as others have suggested. :cwds:


    I would ask someone else at the office. Sometimes I think it's a matter of unwillingness to do the work rather than impossibility.
     
  12. Alex's Dad

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    Excuse me, but are you calling me a liar? What I said was what our endo and cde told us this very tuesday, that it was not worth it to override it, they will denied it, that's what she told us. Now what do I gain lying to another parent in need like me?
     
  13. Alex's Dad

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  14. emm142

    emm142 Approved members

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    I think she was implying that whoever informed you was mistaken or lying - not that you were.
     
  15. liasmommy2000

    liasmommy2000 Approved members

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    I agree get the letter of medical necessity from the doctor. And make sure they word it correctly.

    When Lia was newly dx I was having trouble running out of strips. I kept having the endo's office write new prescriptions for more but the DME company we went through kept telling me insurance wouldn't accept it. What was annoying and frustrating as you know what was that the DME company wouldn't even submit them to insurance. Just handed it right back to me (local company we no longer use them). Money was already tight for us and having to spend a hundred extra bucks a month to get enough strips was not helping. I got advice from others and finally ended up calling the insurance company and asking them what I needed to do. They actually told me to have the endo write the letter, what it should say and how the prescription should be written and gave me the number to have the endo's office fax it to them. I had the strips later that same day and haven't had a problem since. *knock wood* lol.
     
  16. Trev

    Trev Approved members

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    Thats crap!

    I remember once showing up to my pharmacy and having to pay full price for some diabetes supplies not realizing the company had a spending cap for particular items such as strips. Fight it! Like managing the big D isn't enough.
     
  17. kjmaf

    kjmaf Approved members

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    We just went through this also. I called the insurance company and they faxed a pre-authorization form for our end to complete. He completed it and stated that we needed to test 10 x a day to keep blood sugar stable due to brittle diabetes. (He winked at me and told me that he did not know what brittle diabetes meant, but it sounded good to insurance.) The insurance company approved the 300 strips pretty quickly after that. They said he could have also called and pre-authorized the limit increase over the phone.

    I think this is pretty standard practice and is usually pretty easy to override once the endo agrees to contact the insurance company on your behalf. At the very least, it is ALWAYS worth a try!
     
  18. mrcool

    mrcool Approved members

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    We just recently went through changing our strip suppliers and had to do the whole process again. Our insurance limit is 6 strips per day, we had to get pre-authorization from endo office.

    I would call the insurance company and ask what is required to get more strips. It is weird for the endo to tell you that nothing will help. Doesn't he care about his patients? Unless it's a really cold-hearted insurance company?:confused:
     
  19. timsma

    timsma Approved members

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    She wasn't calling YOU a liar, she was calling the endo one. Most times, if the endo calls or faxes in the information the insurance company needs to override the limit on strips, it gets overridden and you get what you need. It sounds to me like you may have a lazy endo. If this endo won't do this for you, I'd find one who will. At the very least, you need to put pressure on your current endo to do her job appropriately.
     
  20. selketine

    selketine Approved members

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    We had a similar issue in the beginning and it was solved the suggested way - the pedi endo told them we test "X" times a day and that number x 30 = the number of strips we get per month. I think we do end up paying a double co-pay but that means like $80 instead of $40 so quite worth it for the number of strips we get.
     

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