Insurance perils

            I have been unsatisfied (that’s putting it lightly), with my insurance company for several years now.  Basically, as long as I’ve had it.  First, it was because I hated paying so much into it that I would never get back.  When it was just The Pretty Lady and I we had no chance of meeting our deductible.  Even now with two kids, one with asthma, and myself with a chronic disease we barely have a chance of meeting our deductible.  This year was the exception because of added expenses after my diagnosis being changed to Type 1 which meant extra doctors visits and tests and more expensive medicine, my son being hospitalized for the second time in 6 months, and my daughter having surgery to put tubes in her ears.  On top of that we took advantage of having our deductible met and I took the plunge to get a CGM (best investment ever, if only the insurance company understood the money this would save down the road), and my daughter had her tonsils removed.  Not only did we meet our deductible, we hit our out of pocket maximum.  Despite that, and the fact that we met our deductible last year, I was still sitting on over $5000 dollars in doctors’ bills.   So, this is my gripe; in the last 2 years I have racked up in excess of $5000 of bills, not including co-pays on insulin, test strips, oral medications, CGM sensors, and inhalers, paid over $7000 in premiums, and haven’t really seen a pay increase at work because the rise in premiums has negated it every year I’ve been in my current job, yet I don’t really feel like I’ve gotten $12,000 worth of service out of them.  And this week I came across what was essentially the straw breaking the camels back on another blog.  And thank the stars that I did find out now instead of the first time I tried to fill a prescription in January because bad things may have happened.

            My insurance originally used Medco for our pharmacy benefits, which merged or was swallowed up by (I forget which) Express Scripts a few years back.  Initially that was of little or no impact to my coverage until this happened.  Express Scripts has announced that they will have a list “excluded drugs” that they will not cover because “clinical data shows there are other products effective in the marketplace.”  I realize that insurance companies are for-profit entities and they answer to shareholders, have to make a profit, etc.  I also understand that pharmaceutical companies have increased the cost of medications and that most of the ones on the exclusion list are more expensive.  I get that the profits of the insurance company take a hit if I fill a prescription costs $200 and pay a $30 co-pay as opposed to filling a $100 prescription with the same co-pay (I’m bad at math, but not that bad).  This move hits me twofold.  I use Apidra as my rapid acting insulin to bolus for mealtimes and treat high blood sugars.  I use an Accu-Chek meter and test strips to monitor my blood sugar and calibrate my CGM.  My son uses Advair as a controller medicine for his asthma.  All three are now on Express Scripts exclusion list.  They recommend Humalog as the equivalent for Apidra.  Although the times it takes for the two different drugs differ, as do the peak times, I am sure I can adjust to this and still manage my blood sugar just fine.  There is a bigger problem with my son’s inhaled steroid.  He was recently switched to Advair by his pulmonologist because Symbicort was not effective at keeping his asthma under control.  The Advair, however, has been great.  He has had no attacks and no need for his rescue inhaler since changing over. There are 2 suggested alternatives to Advair on the Express Scripts list.  And if you guessed that one of them is Symbicort, then you my friend are correct.  There is one other alternative as well, but if it does not work either we will be stuck paying full retail price for this drug.  Express Scripts pays an outside group to analyze the drugs in each group and determine what ones are comparable and do the same thing.  That group apparently has determined that Symbicort and Advair are effectively the same drug.  They are used to treat the same condition and same symptoms, but my son is proof that they are not the same drug and both have different benefits for different people.  If that is true in his case, I have to believe that the same is true for many other people on the other 47 drugs that are excluded from coverage.  Which according to the articles I read, factors out to 2.6% of Express Scripts customers.  Which seems measly, but it’s still 780,000 people.

 

            Perhaps my anger is misdirected and should be directed at the drug companies themselves for their outrageous prices.  But I feel like if I am paying $3500 a year in premiums for “coverage” then I should be getting a little more in return.  Instead, I am paying more and getting less every year.

 

http://www.pharmalive.com/why-express-scripts-tossed-48-drugs-off-its-formulary-miller-explains

Pic-a-day 13- Awareness

My Dexcom CGM keeps me constantly aware of where my blood sugar is, when I am going low, and how the food I eat effects it.  I feel a certain amount of guilt when I have eaten something I know I shouldn't have and hear that familiar tone.

Pic-a-day 12: Work

For the life of me I could not think of a picture to post for work.  But I will say that, although I am often frustrated and not passionate about the job I have, I am thankful for it.  The job itself can be high stress but it is secure and allows me to do what I need to take care of my family, take time when I need it, and manage my diabetes, even when that means sitting down in the middle of my shift to eat a Snickers

Catching up Pic-a-day 9,10,11: Support, Exercise, Play

Support

In the first months of my diagnosis as Type 2 the ADA website was a priceless resource as were the forums.  They are still soooo helpful when I have Type 1 questions or any diabetes related questions.

Exercise

That shoe is definitely not one that brings exercise to mind, but the amount of walking I do at work (10 miles plus some days) is the bulk of my exercise these days

Play

With the weather getting colder, snowboarding season is almost upon us.  Hopefully I can get to the mountain more this winter than in the past.  I can't wait to teach my son the ropes.

Pic-a-day 7: Blue

Earlier this year a co-worker and I volunteered to work an entire night in drag to raise money for the American Diabetes Association.  This is the result.  The scary, scary result.

Pic-a-day 6: Relationship

Diabetes touches every facet of my life, including my relationships with others, and therefore bleeds over into the lives of those I love as well.  Thinking of diabetes and relationships makes me think of one of my first posts from this blog so I'll be reposting it for today.

This is not just my diabetes- 5/23/2013

You are an amazing wife, mother, and friend.  You hold this family together.  You clean, fix, schedule, reschedule, wipe tears and noses, chauffeur, listen, and worry.  You have to experience every high, low, good day, bad day, bad mood, anti-social moment, short tempered outburst, and burn out I have in your own way.  You do your best to understand what I am going through even if you can't be in my shoes.  On the day I was diagnosed, your life changed as well.  When I become depressed, you have to deal with it too.  When I have a good day, I hope it helps you have a better day, but unfortunately when I have a bad day, I know it makes yours worse as well.  When I was re diagnosed, your life changed again right along with me.  You listened to my fears and had your own.  You were there to listen even if I didn't want to talk.  Every step of the way when this disease effects me it effects you too, so in a way this is your diabetes too.

    You are an amazing young boy.  You are growing up so fast, right before my eyes.  When you learned that I shouldn't have sugar you helped remind me.  You are interested in my medicine and every step I take to manage things.  When I am grumpy, down, irritable, or tired it effects you.  You feel for me on my rough days and help bring me out of the funk.  Sometimes you drive me crazy but I know you don't do it on purpose.  You have an incredible sense of who you are and I am so proud of you.  Even though you don't understand how all of this effects you, this is your diabetes too.

    You are my pretty little angel.  My booger, my stink pot, my cuddle-bug.  You are too little to understand how this effects you but it does.  On the days when I don't have a lot of patience, it effects you.  On the days when I am burned out, tired, and can't motivate myself off the couch, it effects you.  But you effect me as well.  When you poke your head around and the corner and smile, the clouds part a little.  When climb into my lap and cuddle up, the day brightens.  Someday you will see all of this for yourself, this is your diabetes too.

  We are all in this together.  Everything that happens to me, effects all four of us.  This is not MY diabetes, this is OUR diabetes.  Having the three of you to experience this with means more than any of you know.

Pic-a-day 5: Advocate

I have been lucky enough the last two years to be a part of the American Diabetes Association Community Walks program, including the inaugural year in 2012.  After being diagnosed I was trying to find programs in my area to meet other people with diabetes but there was nothing in the area.  As I was searching I found the Community Walks program and because of it I have been fortunate enough to meet other people passionate about diabetes, spread awareness, and raise funds for the American Diabetes Association.

Pic-a-day 4: Proud

When it come to being proud I have a lot of things to choose from.  I have a growing son who is smart, inquisitive, funny, and sensitive.  I have fireball of a daughter is all smiles and energy.  I am proud that I am able to provide for them and have the means to manager my diabetes properly and I am proud of the numbers I get when see my doctor every 3 months.  But this lady right here is what I am most proud of:

I picked an amazing woman to take this journey with.  She is a great mother, an amazing wife, and an all around wonderful person.  She is patient, forgiving, loving, and understanding.  I could not get through the bad days without her.

Pic-a-day 3: Snack

I should post a picture today that makes me look like a good, healthy eater.  But I am all out of peas (I really do eat a lot of peas) so you get this instead

I am a sucker for ice cream.  When I first received my diagnosis of type 2 diabetes it was one of the hardest things to give up.  I tried several low carb varieties and just couldn't get past the taste.  The Blue Bunny Sweet Freedom flavors, however, are delicious.  I slowly got back into a more controlled habit of ice cream again and after I got my new diagnosis of type 1 and could regulate it with insulin I felt a little better about it.  I never really was able to see the effect it had on me until I got my Dexcom and found it didn't lead to big spikes and my body handles it pretty well.  Yay me!  If I feel so inclined I can even eat a pint of Ben and Jerry's (which I have been known to do) and have no issues as long as I time the insulin right.  You know, for those times when I run out of peas.

Pic-a-day Nov. 2: Check

I was going to post a picture of the check I write to my doctor every 3 month but that didn't really seem like a good topic.

So instead I am going with.  My Dexcom G4 Platinum.  Which I check about 100 times a day it seems.  I am fairly new to using the Dexcom, having started in August, but it is already hard to remember living without it.  I am still contemplating how I am going to afford the sensors after the beginning of the year when my insurance deductible resets, but I know that it will be very difficult to stop using it.  I read a forum post a few days ago regarding CGMs.  Someone commented saying they did not see why anyone would spend money on one when it had to be calibrated with a meter and the manufacturer says not to make any decisions off the reading but to use it for identifying trends.  Even if all I did was use it to identify trends it would prove invaluable.  Being able to recognize that I don't need as many carbs at breakfast as I do at dinner, or see that my blood sugar is rising or falling prior to bed allows me to adjust my treatment to prevent highs and lows without doing finger prick tests 100 times a day.  That to me makes it worth every penny.

 

Also for the word check.  One of my son's favorite bedtime books is a National Geographic book about sharks.  It explains that sharks take a bite out of their food to taste it and see if it is ok to eat.  Occasionally he likes to make up his own words and read the books to us.  Tonight was one of those nights and for this page he said, "Sharks have to check their blood sugar to see if it is ok to eat."  That kid melts my heart.

To bolus or not to bolus...

Had pizza for dinner even though I knew I shouldn't and I've somehow managed to stay under 160 since.  Now the question is, do I take a bolus before bedtime to insure I don't go high tonight or trust that my number will stay steady and come down?  Damn you pizza!  So delicious but so much trouble!

Pic-A-Day Nov.1- Past

This picture was about 1 week prior to my incorrect diagnosis of Type 2 diabetes.  A month after my daughter was born we took a family trip to Colorado to visit my wife's family.  It was a wonderful trip despite having to use the bathroom twice before we boarded our flight, again during the flight, again as soon as we landed, and at every gas station we passed while we were there.  It was during our stay that I became increasingly worried that something was wrong and I did a quick internet search for "frequent urination" which led me to the website for the American Diabetes Association.  I read through the list of symptoms, silently checking them off in my head.  Increased thirst.  Check.  Frequent urination.  Check.  Constant hunger.  Check.  (This one I blamed on my wife's pregnancy.  Sympathy hunger?)  One of the most ironic statements I have ever made came about a week prior to our trip as my brother made the short trip with me to drop my dogs off at our parents house before the we left.  We were discussing his recent change in diet, having to minimize his intake of sodium, to which I said, "If ever I had some sort of health issue where I had to regulate what I ate I would be in trouble.  If I had to stop eating sugar I think I'd just give up and die."  Famous last words anyone?  Upon returning I used my last day of vacation to see the doctor, who then told me that I had diabetes, based on a blood sugar reading over 300.  And so started my journey...

Despite the constant bathroom breaks and life changing diagnosis at the end of it, this was still one of my most memorable trips with my family.  In fact I still contemplate a move to Colorado pretty frequently.

Pic-a-day

I'll be getting a late start because I never got around to digging up pictures today, but I am taking this from Kerri at sixuntilme.com and posting a picture everyday in November for Diabetes Awareness Month.  Stay tuned tomorrow, the topic is "Past".