With my wife's adventure into startup land, we moved the family health insurance over to my company's coverage with Carefirst. It took me 12 whole days to hate Carefirst with the passion I usually reserve for the New York Yankees or Indiana University.
On about June 12 she called in her refill of Bayer Contour test strips. The Bayer Contour is the only blood glucose reader that works with her Medtronic Insulin Pump. We haven't had an issue with test strips being covered in at least 7 years, so she was quite surprised when she stopped by CVS to pick up 300 test strips and was told the cost would $300, because they aren't covered. For the uninitiated, that 300 supply is about 30-35 days. So we were looking at $3600 a year.
A call to Carefirst didn't help. Apparently they only cover OneTouch brand test strips. The Medtronic insulin pump that only works with the Bayer meter commands over 70% market share in the US. So Carefirst is effectively telling almost all insulin pump users to go die in a fire. How is this even legal? Michelle went back to her doctor, who filed an appeal. I actually thought the appeal would be approved, as we've played this game with too many insurance companies. They make it hard to collect the benefits you rightly deserve. If you are a persistent pain-in-the-ass you can get coverage. Most people aren't that persistent, so Carefirst pockets millions and millions in unclaimed benefits. I'm really not sure how their executives sleep at night. Oh wait, yes I do. They sleep in piles of money.
The appeal was denied. The doctor is now doing a second, more detailed appeal, but I think we all know how that will go. Meanwhile, the doctor is wasting valuable patient time screwing around with Carefirst paperwork. And people wonder why healthcare is so expensive in this country.
While this was going on I got my hands on the actual health insurance contract that my company signed with Carefirst. In the diabetes section it states explicitly that ALL medically necessary and medically appropriate supplies necessary for the treatment of diabetes are covered. Not some, not selected, not only those brands providing an unethical if not illegal kickback. It says all. I read the entire 150 page document. I don't doubt they have an out in there somewhere, but I can't find it. (Yes, I did read a 150 page health insurance contract for me wife. Yes, I am the greatest husband ever.)
Then today, some temporary good news. Michelle suddenly remembered that she might have an old OneTouch meter somewhere, as two pump generations ago it was the one meter that talked to Medtronic pumps. Sure enough, she still had it, and the prescription for 300 test strips went through, without even a copay. (They must be getting one serious kickback on those strips). So we have coverage, assuming Michelle's 5 year old obsolete meter keeps working. I got the idea to see if any were available on Ebay, as a backup. They sell for over $150 used. I'm kind of surprised you can sell them used, given the close contact they have with blood. We didn't buy one. (It's been 3+ years since you could buy a new OneTouch that talked to a Medtronic pump.)
Instead, I filed a complaint with the Virginia Insurance Commission. We got lucky and backed into coverage because my wife is a pack rat. A cute pack rat, but a pack rat none-the-less. I have a contract with Carefirst that states all diabetes supplies are covered, and they aren't honoring that contract. Plus, hundreds or thousands of other diabetics in VA might be out thousands per year due to Carefirst's evil business practices. I should also note that one of the primary tenants of health care reform was to help make chronic diseases more affordable to manage. If Carefirst wants to benefit from thousands of healthy young folks buying insurance they need to own up and offer the coverage they are promising.
Virginia referred me to DC, since that is where the policy was written. So I filed with DC, got a form letter they were working on it, and last week got a call from Carefirst informing me that after hearing from DC they decided that Michelle's blood strips were covered after all. So we have tangible proof of government working here. None of this explains why it took 7 weeks of hassle to get them to do what my insurance contract plainly states they will do. So thank you to my friends who live in DC, as your tax dollars pay the salary of the DC government employee who followed up on this.
I'm currently in the midst of another battle with Carefirst. I will write a new post with that story soon.