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Insurance limiting # of strips

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

  1. SarahKelly

    SarahKelly Approved members

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    This has been such an issue for us too...after six months of fighting the insurance co we got approval from talking on the phone with the right person. Darn it for taking so long to figure out who the "right" person was....so what I would do differently is write the letter to the insurance company appealing right away, have your endo right a letter of medical necessity right away, call right away and ask to speak to the person in charge of the pharmaceutical service department and NOBODY else, speak candidly about what happens to your child due to lows/highs both currently and long term effects, contact your state insurance commissioner (you can do this online) and they will contact your insurance. Let them know from the start that you are a pain in their ass that won't go away until they cover your child for the necessary medical equipment that they need. DAMN this topic gets me fired up, why do we need to fight for test strips.
    Wanna hear the real crap part of it for us - now that we got approval my husband's company switched insurance co's and we get to start all over. YIPPEE!
     
  2. rtjlolson

    rtjlolson Approved members

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    Thank you for all the great comments. I know what I have planned for Monday morning!! I am new to this board but can see it is going to be a great help in managing my son's diabetes.
     
  3. cindyrn6617

    cindyrn6617 Approved members

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    I would get the prior authorization completed by the Endo. If they won't do the work for it, call the pediatrician, ours will help whenever we need supplies also. Most insurance companies, ours included, has a limit due to the cost of the strips. PA completed by the doctor stating why it's needed will usually solve the problem. We have to do PA's alot at our clinic for medications that aren't on the "approved" list for a particular insurance company or the amount of medication that is approved to be dispensed..like 15 is approved but the patient needs 45. Then we have to get the PA. Usually it can done pretty quickly.
     
  4. Beach bum

    Beach bum Approved members

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    I'd consider a new endo if they won't go to bat for you for something as simple as writing a perscription override. They could at least make an attempt to help instead of shutting you down.
     
  5. Mom2Will

    Mom2Will Approved members

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    FWIW, for nearly 4 years now we have fought our insurance, we are allowed 153 strips a month. Letter of necessity, appeals, pleading, you name it we've tried it. Have had 4 different endos all have backed us all the way. The prescription is for 300 a month. I buy lots of strips from ebay, save every receipt from everything diabetes including mileage to and from and itemize it all at the end of the year.
     
  6. Becky Stevens mom

    Becky Stevens mom Approved members

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    Often, for issues like this I wont even ask the endo. I have a great deal of respect for him but he is a doctor and knows nothing about insurance stuff or paperwork. I go right to the CDE and she is awesome! All of a sudden, we were getting 200 strips a month as well and I was confused why:confused: I told the CDE and she faxed a perscription to the insurance company for 300 strips per month and that is what we get now. To me, it only makes sense for an insurance company to pay for the strips now or they can pay for complications later due to not being able to test enough
     
  7. Jacob'sDad

    Jacob'sDad Approved members

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    Sometimes things don't come across in writing the way the person doing the writing intended. She may have just meant that this is not true across the board, even though it might, unfortunately be true with your insurance. Or it may be that your endo has seen others shot down by their insurance in their attempts to get more strips and assumes that the same will be true for you as well. I would push it. I would ask the endo for a letter of medical necessity whether he thinks it is a waste of time or not. For plenty of others it obviously was not a waste of time. The worst insurance can do is say no, but it's never a waste of time to ask. You could even appeal it if they did say no.
     
  8. thebestnest5

    thebestnest5 Approved members

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    Don't give up and don't pay out of pocket for a necessity. Insurance should cover it. Call your insurance and ask the steps for getting approval for more strips. Keep on your doc, use your ped, or switch if you need to.


    I don't know why some docs think this way--but their thinking is flawed. Liv's ped tried this with us last year. Insurance was limiting strips to 200/month. I asked for 300/month. The doc refused and implied that he didn't think we really needed 300/month. He told me that the MOST he has ever been able to get approved was 250/month and that's what he'd do. I told him that I pay my insurance, my DD needs those strips, and I will settle for nothing less than 300/month. I e-mailed the dr. a list of common BG tests needed in a day, an illness day, a low day, etc...

    Doc submitted the paperwork to insurance and we got approval.
     
  9. deafmack

    deafmack Approved members

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    Yes, you are right. I found out from a pharmacist that instead of saying 300 strips a month it is better to say "test 10 times a day."
     
  10. deafmack

    deafmack Approved members

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    One thing that the doctor might be happening is the doctor's office always gets stuck with the same person and that person just plain flat out denies every override. The thing is to ask for a different person to talk with in the insurance office instead of that person.
    The other thing is the doctor and his staff may have no idea how to apply for an override. When my Sister was ready for a powerchair, it turned out the doctor whom she was seeing had no idea how to write the letter of medical necessity for the powerchair. His staff had no idea which code or codes to use, etc. Because of this it took forever, but we didn't give up. My Sister finally got her much needed powerchair after the fire department came 11 times in 2 months to pick her up off the floor and they gave us a letter to give to her insurance company.
     
  11. Beach bum

    Beach bum Approved members

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    That is very, very possible. Our nurse said the letter had to be written in a very specific way, stating patient must test up to x times a day, also write in a blurb where the benefits of testing more outweighs the cost of long term problems etc.

    I would call your insurance and ask what you need to do to get the limit waived, what must be in the letter. If the person you are speaking to can't answer just keep asking for someone who does. Once you have this info go back to your doctor with it and just ask them to put it on their letterhead and sign off on it.
     
  12. bnmom

    bnmom Approved members

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    We had the same issue - ran out of strips a couple weeks after home from hospital, went to pharmacy and they told me insurance said no more. So I paid $50 out of pocket to get 50 strips that night.

    Next morning I called our endo's office - they rewrote our prescription 'test 10x a day'...insurance said no again...so endo's office called them and got a pre-authorization for it. That all took place the same day, so it was a quick process and we had our 300 strips by dinnertime. And sidenote: pharmacy (CVS) then refunded me the $50 I had paid.

    Just wanted to add that you may have to do that periodically.

    My son's dx was in the fall...and the first time I went to get refills in January, pharmacist said 'sry insurance only covering 200'...so I called endo's office and they said insurance company will normally require new authorizations at start of each new year (and again they just made a call and it was taken care of that day.)
     
  13. rtjlolson

    rtjlolson Approved members

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    I just got off the phone with the insurance company. They were amazingly helpful!! The lady I spoke to suggested our Endo write a letter of Medical Necessity and then have them fax it to her so she can get it to the right person as quickly as possible. Now I wait for the Endo to call me back so we can get the letter written! Thanks everyone for your help. This message board is a great support!
     

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