An Almost Seamless Transition

Small blessing. A stroke of luck. Straight-up good karma. Whatever it was that made 1) my overall transition to a new healthcare plan and 2) my receipt of all my necessary diabetes medications and supplies so completely smooth this month, I’m extremely grateful for it – and kind of amazed that it all went so well.

See that above block of text, folks? It’s the reason why you don’t finish writing this type of post until you know exactly what’s gone right and wrong in the transition to a new health plan.

You see, I was counting my chickens before they hatched because, well, things really did go superbly when I refilled some of my essential diabetes medications. I was blown away by how easy it was to obtain my Omnipod 5 pods and my insulin, and even more so stunned by how much my plan covered for both. In fact, I can’t remember a time in my life that I had to pay so little for a 90-day supply of insulin, and for that I remain extremely grateful and very aware that not all people with diabetes have the same experience.

However, getting ahold of sensors and transmitters for my Dexcom G6 was another story. When I told my doctor’s office about my new health plan, I also provided them information from my prescription and health ID cards that they would need in order to get my prescriptions refilled. They took care of contacting my new mail order pharmacy (OptumRx), who sent me my pods and insulin in a timely manner. When I didn’t see any updates from them regarding my Dexcom supplies, I took it upon myself to log into their patient portal and see what kind of information I could uncover there.

I realized that I had a balance to pay for my insulin, so I did that and saw an option to order more Dexcom supplies. Fantastic! Or so I thought. When I hit “submit order”, I was brought to a page on the website that showed me the newly generated order status for my Dexcom supplies…as well as an order total. And that order total was nearly $2,000.

That couldn’t possibly be right…was my first thought. My second thought was to call OptumRx directly and ask if additional information was needed before the order was processed. Maybe my doctor’s office needed to submit a prior authorization in order for me to get my Dexcom at a lower cost. Maybe the system miscalculated. Maybe my Dexcom really would be this expensive under my new health coverage, at least until my deductible was met. Whatever it was, I vowed right then and there to get to the bottom of it so I could get by knowing that I’d done my due diligence on the matter.

One 10-minute phone call later, and I had an explanation: For some reason, OptumRx had duplicated my account information. The representative that I spoke with didn’t really elaborate on this; rather, she muttered here and there as she seemingly went through my data and cleared out information that was repetitive or irrelevant to me and my needs. By the end of the call, she was reporting that my Dexcom sensors and transmitters would cost me roughly $500 for a 90-day supply (infinitely better than 2 grand) and she processed the order so I’d receive everything in just a few days. Finally, just about three weeks into the new year and my new health plan, and I was on track to have all the diabetes supplies I need. Those three weeks are nothing compared to what I’ve dealt with in the past, but it definitely felt like a long time considering all the uncertainty and nerves I felt about costs.

Ultimately, I suppose that my almost seamless transition will serve as a reminder to be appreciative when things go in my favor, and to enter into full-on detective mode when they don’t so I can get what I need, when I need it. And I guess it doesn’t hurt to try and remember that having a back-up supply of all major supplies on-hand at all times can be an absolute saving grace. In this particular scenario, it’s the reason why I never really panicked because I knew that I had a reserve to fall back on, and that I wouldn’t let it deplete until I had all my ducks in a row for replenishing it.


5 thoughts on “An Almost Seamless Transition

    • Hi! Basically, I just refill prescriptions as early as possible. Sometimes doctors have upped my limit so I’ve been able to get more, faster. It helps if I let them know that I’m switching health plans – they know it can take a long time to get all that paperwork taken care of, and as a HCP they want to help their patient avoid running out. It only takes 1-2 times of an upped limit to accumulate things more quickly. Hope this helps!


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