There are companies that serve the public with more feeling toward their stock holders than toward their patients. I have said time and time again, health insurance companies fit this bill more than any other company I know. I also believed that little can be done to fight these corporates giants…………..until recently.
There was a two-year-old young lady who was denied by Heath Insurance giant, Humana, an insulin pump and a CGM even though her doctors stressed the importance, their policy allows it, and her mother followed every step necessary in application and appeal. But once the Diabetes Community became involved in an avalanche of feedback; the young lady not only received her devices; her mom shared that she received a letter of apology from Humana.
Our voices were heard.
Little did I think, at that time, that it was a testing ground for a larger and swelling problem facing so many of the people who battle diabetes. It’s actually a problem so many are well aware especially with the recent letter by a pump company that they were squeezed out of a health insurance company’s coverage-plan. Insurance companies making decisions on what gets covered and what does not get covered. Many times leaving the patient out in the dark on what to do.
Recently United Health Care made the decision that only one insulin pump would be their ‘preferred’ insulin pump leaving many to scramble or prepare to fight to keep the pump they use and have covered. Another insulin pump company released a letter stating the unfairness this will be toward the many patients who use their pump, as well as others. My cynicism tells me that the pump company was not as concerned about our welfare as much as their own pockets except that the company is Tandem, and Tandem is a different company for many reasons as many of us have come to know in the diabetes community. That said, Tandem outlines a growing problem. And the diabetes community is gearing-up to react.
Decisions being made that patients have little, or no, say but must bear the full force of inconvenience and or healthy concerns needs to be changed. This is about insurance companies making decisions based on ‘bean counting’. If 70% of their covered patients use the device, and they can negotiate a really good price and under-cut the competition; great for the 70%.
Problem is, that leaves 30% of a health insurance company patients to figure out if they are ‘grand-fathered’ in or fit the bill or have to switch devices. Multiply that by quite a few insurance companies….and we have a problem……a BIG problem.
This problem is growing.
What I learned from our situation with Humana, is that our voices matter. But they must be loud; and they must be clear.
This is not about one insurance company’s decision; this is not one diabetes company accessing a better deal for their stockholders; this is about US. US not having a choice in what decisions are being made, but yet, have to burden the brunt of something that impacts diabetes care hugely. We need to have some say. Right now we have little; if any.
We need to collectively do something.
The first thing we need to do—is collect stories—–lot’s of stories. Let your voice be heard. If you have been denied anything related to diabetes; if you have had your coverage changed; if your insurance company has changed anything and not asked your input in any or all of the examples listed, or you have your own story—-please share your story here.
There will be more on this topic in the future—-but for now—do one thing—–go to the link above and share your story. Do not be afraid to use names and be brutally honest what it meant, and how it, impacted you.
The first step is to show a problem. Please do so. Click the link and tell your story.
I am a diabetes dad.
Please visit my Diabetes Dad FB Page and hit ‘like’.
0 thoughts on “NEWSBREAK: Diabetes Voices…..We REALLY Need You NOW!!!!”
Our story I have been sent numerous letters of denial letters for medically necessary medicine by Unitedhealth care. Why did they deny diagnoses does not match the medication. Really diagnoses code diabetes medication insulin. Delays in refill for her Dexcom when the transmitter went out. It took two to three months and a hospital stay to refight. Why do we keep them because they are the only Medicaid our Endo takes and our area has a shortage of specialists. Our Endo is awesome and board certified other on other plans are not the same quality of care in training nor certification.
Please make sure you add your story through the link in the article. Thank you.
Rick Phillips says:
We have a terrific opportunity to collect our stories and make a great difference someday.
I referred your blog to the TUDiabetes web page for the week of May 9, 2016.
Samantha Arceneaux says:
I am a volunteer insurance advocate and have completed dozens upon dozens of appeal letters for CGM’S and pumps for pediatric patients. I can give you plenty of dirt if you’d like to contact me.
Dirt? No…but would love to pick your brain on the hurdles and how to navigate them.