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Sudden major trouble getting test strips, what gives??

Discussion in 'Parents of Children with Type 1' started by Debdebdebby13, May 14, 2013.

  1. Debdebdebby13

    Debdebdebby13 Approved members

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    From the time Molly was diagnosed to now she has been getting 200 or 300 test strips per month. Ever since we started pumping last summer it's been 300/month.

    At times, when it was time to send a new script because it expired we've had some trouble, the doctor's office has had to call in and override because the insurance co doesn't want to pay for that many. Every time up until now that has not been an issue.

    Now all of a sudden, they basically don't want to cover ANY test strips. The doc's office called and I don't know if it's because she called United HC, rather than our pharmacy coverage company, Express Scripts, but they said our test strip is "covered" but they are only willing to cover 30/month!!! No amount of explaining that this is a 6 year old child with type ONE diabetes would make them budge.

    We've been running around in circles for a week about this for a week, and now this! We can't afford to spend hundreds of dollars a month just on test strips! I am so confused because we've never had this problem before. Prior to this we filled at Walgreens and we'd get 300 easily with the override from the doc. We haven't changed insurance companies, nothing has changed.

    What do we do??
     
  2. Beach bum

    Beach bum Approved members

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    UHC is now using OptumRx for scrips. It was effective in April. Call UHC to verify but I am pretty sure this was a company wide change. Paperwork was sent out a while back
     
  3. 3kidlets

    3kidlets Approved members

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    Not everyone under United is using Optum. It depends on your coverage thru your employer. We are still using express scripts and were told that this does not pertain to our coverage. We will continue to use express scripts.
     
  4. 3kidlets

    3kidlets Approved members

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    I'm trying to cut and paste a Facebook post from Gary Scheiner here but I'm not able too. Anyway, I knew I had seen him post about this a few months ago and found the post. It said that Medicare was going to start drastically cutting reimbursements for tests trips. It said that private health plans usually follow medicare's lead and this will have a ripple effect on he diabetes market. I have no idea if this is what you're experiencing, but found it interesting (and disturbing).
     
  5. jellybeanasmommy

    jellybeanasmommy Approved members

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    If this is true, that is disgusting! Seriously! I guess insurance companies haven't caught on yet that their patients being able to test less often is going to lead to a lot more people with diabetes that is poorly controlled which is going to translate to more $$$ the insurance is going to have to spend to FIX it instead of PREVENTING it in the first place by paying for test strips.

    Sorry, I don't have anything helpful to add to the original post, but saw this and it made my blood boil. Our insurance limits us to 300 strips per 30 days, and they are strict about that 30 days, but so far no issues with them paying for that amount or less. My daughter was just dx'd back in March and I am getting ready to start mail order through our insurance, so far I have been getting them a month at a time from Walgreens.
     
  6. Beach bum

    Beach bum Approved members

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    Interesting. When I called UHC, they gave me the impression that Optum was an in house mail order that they had switched to and it was for all UHC customers.
     
  7. Debdebdebby13

    Debdebdebby13 Approved members

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    We are still Express Scripts with UHC, in fact that change just came sometime in the last year or so, when Express bought out Medco, or whatever happened.

    I called Express and they said it all messed up from an information input standpoint at the Walgreens level. Apparently they were supposed to enter 300/month and they entered 300/3 months which bumped us down to 100/month because insurance won't pay for a 3 month supply from a retail pharmacy. Why the insurance was telling the doctor only 1-3 strips/day were covered, I don't know. When I called Express they seemed to think that was all because of the incorrect information put in by Walgreens.

    I went to Walgreens steaming mad, just at the whole dang situation and asked for the pharmacist and he was very gracious and nice, fixed the error and then all of a sudden it said they would cover up to 8 strips/day! Voila! So I filled the script at that, because I'm calling it a win in my book at this point, and got 200 strips for 25 days, which we can certainly work with.

    The doctor's office is writing the prescription for 300 strips/month for Express and we are going to mail it off once we get it and hope that going through the mail order pharmacy straightens everything out...will it? I dunno.

    I still don't understand why when the doctor called the insurance co they stonewalled her at only 30 strips/month and then an hour later I got to Walgreens and get approved for many more than that???

    Puzzling for sure. I'm thinking the battle is not over, but I'm somewhat relieved that we are taken care of FOR NOW.
     
  8. ecs1516

    ecs1516 Approved members

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    I would have endo fax to Express Scripts. That is what we do and it makes it faster.
     
  9. caspi

    caspi Approved members

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    We just had a recent issue with Wal Mart pharmacy similar to this. We had to switch to Wal Mart last year when our insurance company dropped Walgreens. We had always received 300 strips a month. That's what the doctor's office rx's and that's what was always filled. Well last month our rx was up and for some reason when Wal Mart put it through, it was only for 200. They were trying to tell me that it was the doctor's office but that wasn't true. I told them that Walgreens always found a way to over-ride that but the staff at Wal Mart were clueless. Mind you they had been filling the rx at 300 for the past 11 months, lol. Long story short we went back to Walgreens (I didn't realize our insurance had put them back on our list of pharmacies) and all is well again. I swear dealing with pharmacies and insurance companies is a full time job!
     
  10. Joretta

    Joretta Approved members

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    I was lead to believe this too. But it is a roll out in phases. Private insurance changes as they renew contracts. Is my understanding.
     
  11. Meredith

    Meredith New Member

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    Same problem with UH

    I had this same problem with united healthcare...after spending days on the phone a finally spoke to someone that made sense... Apparently they did not know my daughter was a type 1 diabetic and this cleared up everything, also I use CVS and never have a problem now after the over ride.
     

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