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Insurance suddenly limiting strips

Discussion in 'Parents of Children with Type 1' started by KylesMom, Sep 25, 2011.

  1. KylesMom

    KylesMom Approved members

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    Last week the pharmacist told me we test my ds too much. We are going to the endo tomorrow and will get new perscriptins written so that we can go elsewhere, but we did go back this one last time to pick up our refill of testing strips (we had to buy them on our own to get through this past week).
    Anyway, when my husband went to pick them up she told him that our insurance is only allowing 204 strips per month vs. the 300 per month that we have been getting, and the the Dr. wrote the perscription for. Doing the math that allows less than 7 strips per day--yeah right!!

    Of course we need to call the insurance and we also see the Dr. tomorrow, but I was wondering if anyone else's insurance limits their strips like this regardless of what the Doctor orders the perscription for. It is really weird to me because we have been getting 300 per month no problem for the past year, and our insurance hasn't changed at all. Anyone else experience this? We have Anthem insurance.
     
  2. obtainedmist

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    We have Anthem as well and haven't encountered this YET! They did deny coverage for the glucagon this year, though:mad::mad:! I would call the benefits line and see if it's the type of strip you are using that has been limited. I've read about that on the forums recently. Hope it gets resolved soon...I know how pricey those are out of pocket!
     
  3. GAmom

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    I don't have the same insurance you have, but I do know once every year we have to call the insurance people, who have to call the dr, and the pharmacy, to say yes, we get 300 test strips as stated on the rx.

    I wonder if there is some kind of default number of strips (probably because the vast majority are type 2 and dont test as much), and it is always has to be reinstated on the pharmacy computer.
    I count my test strips at the pharmacy and do not pay for the order until it is "right."
    When we get our annual glucagon pen, I also check the glucagon expiration date (to make sure it's lasts at least a year). Been burned there, too.

    Did they correct your order for you? If not keep calling the insurance co., endo. or pharmacy until it is correct.

    Do you feel the pharmacist is the problem? Perhaps you can suggest to him/her you will fulfilling your order elsewhere if they can not do it correctly. Many here have had good success with mailorder.
     
  4. tiger7lady

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    Our insurance started that last year. We had to get an appeal form from the insurance company, have the doctor fill it out, and then fax it back to the insurance. They approved the increased number right away. Call your insurance, they probably have the form. Hopefully it's not too much of a pain.
     
  5. zoomom456

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    It is very common for insurance companies to set quantity limits on prescriptions. I've had UHC in the past and now have BCBS. With UHC we had our endo call for a prior authorization with no problem. For BCBS our endo had to fill out a medical exception form and that was approved until 2099! Generally the procewss took about a week.
     
  6. NeurosurgeryNP

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    Denied coverage for Glucagon? That's outrageous!
     
  7. Sarah Maddie's Mom

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    "Prior authorization". Lovely words, put them to use ;)
     
  8. sdneese

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    I have had the pharmacist tell me I was giving my son too much insulin. She told me the one month supply should be lasting 90 days. We get a box of five pens, each pen fills up two pods, each pod last three days max- that equals thirty days. When I calmly did the math for her, she told me I should try cutting his insulin in half. I told her when she became his endocrinologist, I would try that. Dealing with people who should understand diabetes can be incredibly frustrating sometimes.
     
  9. timsma

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    Wow. Just. Wow. What business is it of hers anyway?!?!?! I think I'd be reporting her to her supervisors. That is just insane!!!
     
  10. hdm42

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    I agree, report her.

    And for the OP, as the others have said, talk to your doc about the limit. It is probably just a matter of the right buzzword or form from them to the insurance company. When we switched to CIGNA last year, our endo had to place an override/pre-authorization in for almost every script. It took a while, but it did get sorted eventually and now we get what we need.
     
  11. lynn

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    Our insurance allows 50 strips a month for diabetics not on insulin and 100 strips for those who do use insulin. I had to talk to a case manager at the insurance company to get enough strips. When I told her how shocked I was at the low number allowed she said that Nathan falls into the .7% of diabetics insured by their company---a little kid with type 1. It wasn't a problem to get it fixed once she understood the situation.
     
  12. KylesMom

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    That's a great answer! I like that!

    Thanks everyone...that makes sense that we just need the doctor to send additional paperwork, and it makes sense since it has been exactly a year this month, maybe its a yearly thing. I wanted some feedback first so I knew some specific things to ask the insurance and the Dr. for. As always you all so helpful! Thanks again.
     
  13. emm142

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    So they thought 3.3 strips per day would be okay for an adult with type 1? Things might get a little bit easier with age - but not THAT much! I can't imagine a policy of 100 test strips per month being safe for anyone with T1.
     
  14. obtainedmist

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    Yep, our policy changed so that it would only cover injectable insulin and no others. We appealed and won!
     
  15. jcanolson

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    Our friend's were just told that ketone strips are not covered under the diabetes coverage on their insurance. The pharmacist was even stumped. And best of all, the insurance is through the HOSPITAL that she works for.

    We had problems getting the right number of strips until I was told the code words for the endo to put on the script. "Test 8-10 times per day". Haven't had a problem since.
     
  16. mom24grlz

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    we also have anthem insurance (along with medicaid and BCMH). We were originally told only 200 strips per month. We had to have our endocrinologist do an over ride and so far no problems getting the 300 strips.
     
  17. mom24grlz

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    oh my goodness us too!! We had a heck of a time getting our glucagon.

    First Anthem wouldn't cover it. So pharmacy contacted BCMH. But they would only cover it if we went through medicaid first. Well medicaid's computer's were down for like 24 hours. So we had to come back the next day to see if anyone would cover it.

    Thankfully medicaid covered the glucagon 100%. I can't believe that anthem wouldn't cover it though.
     
  18. obtainedmist

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    Apparently they are going to change that soon (according to the woman we worked with in the appeals department). We wrote a very emphatic letter saying it was like not covering an epipen for someone with a peanut allergy!! Our endo's insurance lady has been VERY busy lately writing medical necessity letters for the patients with Anthem. Sheesh!
     
  19. Tigerlilly's mom

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    Yes, I was about to post the same thing. Thankfully all the paperwork is handled by the endo's office:cwds:.nothing more than a call for me.:D
     
  20. Jordansmom

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    Its very weird because I just filled a glucagon script for school and had no problem with Anthem. the pharmacy didnt even mention it.

    However I did have a problem with Animas sending me 4 boxes plus some loose cartridges instead of the 5 boxes I have always gotten. When I called them, they said their rx policy had changed and they were only filling for the exact number the Endo wrote for. We have always had a script written for site changes every two days. In the past we got extra because we were changing every three days. Now that we actually do change sites every two days, their new policy does not leave room for even one bad site or the occasional flubbed site change.
     

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