I am one month into my new health insurance plan, and I’m more confused than ever.
I’ve sent several emails. I’ve engaged in a number of live chats. I’ve made countless calls to my insurance company, my insulin pump provider, a mail-in pharmacy service, and my CGM provider just to try and get some answers. And almost every time I hang up the phone or walk away from the chat service, I feel lost because nothing is clear to me.
Am I stupid?
I can’t be the only one who just doesn’t get how it all works…right?
Why can’t I just get definitive answers as to how much I’ll need to pay for insulin each month?
Why does my health insurance company advertise a partnership with a mail-order pharmacy that puts a cap on insulin costs…when in reality, it doesn’t (or at least, nobody has informed me that it does)?
Why am I learning, at this stage in the game, that my prescription plan isn’t integrated with my medical plan, which means that any prescriptions I fill using the mail-order service don’t qualify towards my deductible?
Why is it all so convoluted?
As mystified as I am by all of this, I’m coping with a strategy that my parents have helped me develop, which I’ll share with you: Anyone who is going through all of this right now, or anyone who is about to go through all of this, needs to remember to be their own advocate. (I’m reminding myself to do this on the daily.) Frequently, I tell myself that I have every right to make as many phone calls or contact efforts as needed until I understand the costs associated with reordering my supplies. Although it’s easy to get frustrated when a representative on the phone speeds through an explanation or provides contradictory information, it’s important to stay focused on the task at hand.
As I continue to figure all of this out, I’m going to take note of questions that crop up and have a notepad and pen in hand any time I make a call. I’m keeping track of all messages exchanged online and I’m using the next couple of weeks as my fact-gathering stage. It’s almost like I’m assembling pieces to a puzzle…a ginormous, complicated puzzle, but one that will result in a more complete picture of the cost of my prescriptions going forward.
Hugging the Cactus 
When I started my new job a little over a year ago year ago. I ran into the same issue. I had met my prescription deductible so I checked into getting a refill on my Dexcom. Much to my surprise she told that it would cost me $795 for the transmitter and $135 for the sensor pack. I also asked why so much. I was told by the supply rep that my insurance has 2 separate deductibles. The Dexcom is considered durable medical equipment which puts it under the medical side of the coverage. The $500 prescription deductible is a separate amount than the $750 medical deductible. I reality have a total deductible of $1,250. I’ve heard of worse but at the time it still came as a shock. I hear you loud and clear Molly. Another issue I found disconcerting was that my doctor appointment copays apparently do not get added to the deductible either. If it did. It would not have been the full $750 at that point if they were.
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