3 Tips for T1Ds Transitioning to New Health Insurance Plans

This blog post was originally published on Hugging the Cactus on May 8, 2020. I’m sharing it again today because had I known these 3 tips when I first got my own health insurance plan, I would’ve saved myself from a whole lot of trouble – and headaches. Read on to learn more…

Just over 365 days ago, I made the switch from my parents’ health insurance plan to my own plan, provided by my employer.

In the last year, I’ve learned some important lessons about being responsible for my own healthcare coverage. Some lessons were easier to learn than others. I figured it might be helpful to others who just made the switch themselves (or who will be doing so in the near future) for me to sum up three big takeaways I’ve discovered along the way in the hopes that it makes the transition a little easier for those individuals, or at least saves them some time down the road.

Navigating the confusing world of health insurance has taught me quite a few lessons.
  1. Take advantage of a flexible spending account (FSA), if the option is available. I grew up knowing that FSAs exist – my parents would always bring their FSA account cards to all my doctor’s appointments and pay for all of my supplies using those cards – but I had no idea what the big deal was about them until I switched to my own health insurance plan. Basically, FSAs are a great employer-sponsored benefit because they allow account holders to pay for eligible medical expenses on a pre-tax basis. So those who have an FSA are able to pay for things they need tax-free, and the money is typically available to account holders on the first day of the health insurance plan year. My current health insurance plan allows a maximum contribution of $2,300, so I was able to put up to that amount on my account for 2020. It really comes in handy because my wallet doesn’t take as much of a beating from all of my necessary (and very expensive) diabetes supplies, and unlike the last half of 2019, I’m not paying as much out of pocket after my deductible is met.
  2. Keep records of everything. It might seem fussy to hold onto any and all receipts or transaction records, but there might come a day when one is needed. Case in point? At the end of 2019, my company announced during open enrollment that our FSA administrator was changing…which, at the time, I didn’t think was a big deal. I knew what the maximum contribution was, and I figured I’d only need to log into my FSA account sporadically to see how much money I had left for the year. Well…I was wrong about that. Back in February, I got a notification that I needed to submit verification of purchases of my regular OmniPod shipment, Dexcom sensors and transmitters, and my Humalog prescription. And you can bet your bottom dollar I didn’t have receipts for all three of those transactions because, well, my old FSA provider never once asked for receipts. As silly as it sounds now, I guess the thought never crossed my mind that my new FSA administrator would need purchase records. Long story short, I was able to submit an explanation of benefits in lieu of the receipts, but it would’ve been easier just to hold onto the original records (and I can assure you I’ve done that since this whole incident).
  3. Don’t be afraid to ask questions when things don’t add up. I had my annual physical in January and I had quite the shock when I was billed over $300 for all of the lab work that my primary care physician had me do. The moment I got that charge, I knew something wasn’t right – never before in my life have I been charged that much for a standard battery of tests that I take for my physical. So I wrote in to my PCP’s billing department and asked about the charges. That’s when I learned that I was mistakenly charged this amount and that I needed to reach out to my health insurance provider to re-run the charges. Although it was a little annoying to have to go back and forth between my health insurance provider and my PCP’s office, it was worth it because I saved myself $300 that I never actually owed in the first place. This taught me the importance of asking questions and following up with people until I understand, well, anything that’s confusing to me when it comes to my health insurance.

Stress, Anxiety, and Health-Care Open Enrollment

Open enrollment season has officially started and I am officially stressed about it.

Like many employed Americans, I have health insurance through my workplace plan. My yearly opportunity to choose my benefits for 2021 kicked off on October 15th and I have until the 29th to make my elections.

I can’t stand open enrollment season.

What, exactly, makes me so anxious about open enrollment? Well, for starters, I’m never certain that I’m choosing the best plan for me. I know that I’m extremely lucky to be able to choose between three different options – many others aren’t so fortunate – and truly, my company offers tools to make the process as smooth and understandable as possible.

But…health insurance matters are confusing!

There’s too much math involved for me, a person who considers herself allergic to basic arithmetic!

There’s too much unpredictability in it all – how am I supposed to know how many times I may need to meet with specialists next year? How am I supposed to forecast any possible health issues besides my diabetes? How do I go about guessing things that are impossible to guess?

Do I stick with the plan that I’ve been on for the last year and a half or so, that has high co-payments for my doctor appointments but the lowest deductible? Or do I change it up and go on a high deductible plan with a lower premium?

Please reassure me that I’m not the only person with diabetes who absolutely loathes this entire process and overthinks it every step of the way…

DASHed Hopes

It’s funny how much I’ve changed regarding diabetes and technology in the last decade.

I grew up not wanting to try the latest and greatest devices. I had zero interest in an insulin pump and was very set in my ways of doing multiple daily injections and finger stick pokes.

My (semi-forced) introduction to CGM technology when I was in my teens, though, changed everything for me. And I haven’t looked back since then. Actually, if anything, I’ve become more curious and excited about new technologies because they symbolize greater freedom from the heavy burden of diabetes.

So imagine how PUMPed (hehehe, diabetes humor) to hear about the redesigned OmniPod insulin management system!

This next iteration of OmniPod is known as the DASH system and it’s freaking cool. The clunky PDM has been upgraded to a sleek, touchscreen format and it’s rechargeable (no more AAA batteries). Plus, it comes with a whole host of upgrades and features that make the first generation of OmniPod look totally outdated.

Naturally, I wanted to give the DASH system a SHOT (LOL look at me, I’m on a roll with the puns).

it's not always diabetes' fault (1)
I took this image from the Insulet/OmniPod website so you guys could see how awesome the DASH system looks!

So I called Insulet and asked whether my insurance would cover the new PDM and pods, and how much everything might cost me. I learned that the major difference between how I receive pods now and how I’d receive the new DASH pods (because the DASH pods use Bluetooth, I can’t use my old radio-frequency-enabled pods with the DASH system) is that instead of getting pods directly from Insulet, I’d actually receive them through my mail-order prescription service (Express Scripts). That was fine by me – I get the pods in the mail anyway – but I wanted to know how it’d work in case a DASH pod fails on me. I was reassured by the representative that I’d still call Insulet to receive a replacement, just like I do now.

Okay, good information to know. But I really wanted to know about pricing. So I was connected with an Express Scripts representative, who informed me that the cost for a 3-month supply of DASH pods would be about $50 more than I pay now for my current pods.

I did the math. That’s around $200 more each year that I’d have to pay for my pods. That might not seem like a lot of money, but I pay right around that amount for a 3-month supply of insulin. Hypothetically, let’s say that I become financially strapped in the future, and I have to make the choice between paying for insulin or paying for my pods – when it comes down to it, obviously I’d choose insulin – but I shouldn’t have to make that choice.

So it looks like my hopes to go onto the OmniPod DASH are, well, DASHed (sorry, last bad pun, I swear) for now. I’m a little disappointed, but I’ll keep my fingers crossed that prices are lowered for DASH pods in the near future so I can take advantage of a very nicely designed, high-tech insulin pump system.

 

Any Pods to Spare?

Not too long ago, the following message appeared in the inbox of one of my social media platforms:

I’m so sorry to bother with something like this. I down to my last pod. And.. currently I’m having insurance issues.. I was wondering if there were any pods you could spare? I’m trying to search around. Or if you know anyone that does have extras? Or samples? I would hate hate to return to multiple daily injections.. I know u understand that. If not it’s ok. Sorry to bother. I don’t know where else to try apart from everything else I’ve tried

When I read it the first time, my heart immediately sank. The message was fraught with desperation, as evidenced by the typos and fragmented sentences. My gut reaction was to reach out to this person and let them know that everything would be fine, that there had to be an option out there that would help them.

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No pods to spare.

My next reaction, though, was pure skepticism. I’m not proud to admit that, but here are the facts that I was facing:

  1. I did not know this person. I tried to look at their profile to see if I could learn more about them, only to discover that it was private. I couldn’t see any of their information, other than a minute profile picture and numbers regarding their followers/activity.
  2. This person said they might be forced to go back to MDI. Personally speaking, if I ran out of pods and had to go back to shots, I wouldn’t like it – but if it was my only option, then of course I’d do it. I did it for something like 17 years before ever trying a pump. It sounded like this person wouldn’t want to do it, but…
  3. Most importantly, I do not have any pods to spare. I’m not sure why this individual thought that I did. It seemed like they’ve been asking as many people as possible on social media for pods, which makes me believe that they’re exploring the #omnipod or #podder hashtags. Regardless, I rely on regular shipments (every three months) from Insulet in order to maintain the bare minimum of pods that I need. And I can’t exactly give up “spare pods” that I don’t even have.

As horribly as I felt for this person, I had to take into consideration the facts that were in front of me, as well as the unfortunate truth that you can’t trust everything on the Internet. I told them that they should try to reach out to Insulet for assistance, and that I would be hoping for the best for them. I know that my kind words probably brought little comfort, but it was all that I had to offer to this total stranger.

The whole exchange haunts me. That’s why I want to know…

What would you have done if you were in my shoes?