I have worked for state government for over 22 years, and during that time have really only had 2 different insurers. For the first half it was blue cross blue shield. More recently it has been United Healthcare.
BC/BS always seemed to cover what I needed, but admittedly I didn’t use it a lot at the time. In September 2016 my daughter was diagnosed with T1D at the age of 6. From the very beginning UHC has been a constant struggle. They denied her use of Dexcom saying it wasn’t effective for people under 8 years of age. Thankfully when submitted under the Optum pharmacy plan it was approved. Then they denied her use of Omnipod saying it wasn’t the preferred insulin pump. I asked which one was and they wouldn’t tell me but I knew damn well it was Medtronic. Once again thankfully when it was submitted to Optum it was covered. Now the newest development is when the pharmacy sent in a new prior authorization for Dexcom it was denied saying Dexcom is now a plan excluded drug. This will probably mean that we will have to try to get Dexcom as Durable Medical Equipment rather than a prescription which will cost us approximately $2000 more a year.
I plan to write our governor and legislators to ask them to consider more than just price during next bid for insurance for our state, but I’m wondering if BC/BS has been better for most or not. If anyone currently has or had BC/BS in the past can you tell me how you like it. Has it covered all your diabetes needs without limiting choice? Are you able to get the supplies you need for a reasonable cost?
Any information you can give me would be appreciated. Thanks.
It is hard to find anybody speaking well of United Healthcare (UHC).
Have you checked to see if your State has supplemental insurance available for Children?
I just received this email from Omnipod related to UHC coverage on February 6th if that is of interest.
I’m very sorry you’re having to fight insurance while also managing your child’s T1D.
Young children can qualify for disability which is mostly to help with qualified care but I believe would also qualify them for Medicaid. She is 8 which disqualifies her for that. Plus I believe we make enough money to not qualify. I don’t mind paying what’s fair. I just don’t see how a prescription we filled 3 months ago can’t be filled today when the only change is a new prior authorization was needed and that’s been denied. If it was a new plan then fine. But I don’t think they should be able to change coverage within the plan year. FYI we have a funny fiscal plan year that ends in June.
Yes. Thank you. So far we have been getting the Omnipod without problems, after fighting vigorously. Dexcom evidently is being removed from the pharmacy plan, so we’ll be forced to get it as DME instead of paying $100 a month for the prescription will pay 100% out of pocket until deductible is met then 20%.
My impression is that BC/BS coverage really depends on the plan and state – but that UHC seems to be uniformly awful to deal with.
Unfortunately, I had some job disruption after my son was diagnosed and so I have been on 3 plans while trying to obtain everything we have wanted from insurance companies. I will say, that these fights and the continued effort required to get everything you want is one of the biggest frustrations of having a T1, even without accounting for the money required, just the effort to obtain prescriptions, check that they are correct, find someone to fill the prescription, find someone who will remind you when they are due, fight when the insurers change things without notifying you, etc etc. I finally just succumbed to putting everything in a spreadsheet to try and keep track myself. I have PM’d it to you in case you find value.
Very sorry to hear this and what an asanine thing for them to say. It’s approved for 2 years of age and up and I know it’s saved our family in more ways than I can ever even speak too. Before it, I never slept…after it, I am able to sleep. I would fight this. If you need “use cases” where it’s been life-saving for families, you can point to any parent of a young child in this forum and others about it’s “effectiveness,” including me. I hate the beurocracy that is the wonderful American healthcare system.
Sorry. I read too quickly and missed that you won the battle to keep Omnipod covered. That’s good!
My Dexcom supplies was always covered under my DME coverage on my old insurance. Under my current insurance, it is covered thru a dedicated pharmacy plan which is probably unique to my coverage.
I have had various iterations of BCBS coverage over the years. I must admit that I do not fully understand what is apparently common practice in some enrollment aspects but really feel like loopholes…For instance, when enrolling in my husband’s annual insurance coverage four years ago, another T1D family on the same plan gave me the tip to not enroll in his employer’s state BCBS plan but to ask for an exception into the neighboring state’s BCBS plan which had much better coverage?? I did…and it worked out great…but why is this okay?? I have no idea to this day. In the last year, my husband’s employer has actually made that neighboring state’s BCBS coverage the default for everyone. This all still seems like strange insider knowledge that I wish I had a better understanding of.
Overall, BCBS has been fine to work with so long as I keep tabs on every step of the error chain. I know my endo’s nurse (who fills out the paperwork) really well and I know all of her communication preferences in getting requests from me. I keep notes of all phone calls and extensions when speaking with BCBS about anything. I have had to get good at learning the ins and outs of Prior Authorizations. Handwritten letters from doctors on practice letterhead can be quite powerful if they are willing to do that. That’s how I got enough test strips for my high risk pregnancies both times.
Ultimately, T1D and finances have defined my life trajectory immensely. I would have stayed home with my babies if we could have afforded it at the time, but I held the better insurance. My husband’s employer at the time could not offer great health insurance…so premiums would have cost us $19000 a year BEFORE considering the high deductible. That plus losing my income was obviously not possible.
Ultimately, keeping good notes and getting along with my doctor’s office and pharmacy have helped me on most things. I’m sorry we all have to battle this stuff.
Sorry to hear this, this kind of bs makes me want to rip out what little hair I have left. I don’t know if it’s feasible for you but I do know of one friend who pays out of pocket for their omnipod system for about $300/ month. That might be an option during the meanwhile while the insurance run around plays out…
It seems that each insurance company has its drawbacks, but UHC seems to be the worst in almost every way.
BCBS is different than most of the other large insurance companies in that it’s actually an association of many different companies/plans. The coverage and policies vary by plan/company. If you look at the wikipedia page, you can see all the different companies/plans. Each company has it’s own license and region.
While UHC, Aetna, or Humana might offer many different plan types for each state, they’re all a part of the same huge company. The claims process is pretty similar across most of their plans (though the benefits and networks differ). Whereas each BCBS company will have it’s own procedures and claims processing office (though I’m sure there are network agreements that span all the companies).
Anyway, I guess my point is that you may want to be more specific about the BCBS company with which you’re hoping to obtain a plan. When you look at reviews of BCBS, make sure to check which company is being reviewed. If it’s not the company you’re hoping to get a plan with, then the review is not applicable.
While true, you also have to factor in that many large entities (employers) decide on the coverage they want, and these companies just administer the employers plans.
For instance, when I worked at MDT I had a co-worker that switched to a competitor because that company offered amazingly better reproductive coverage. These plans were administered by the same insurance company, but had hugely different coverage.
Yes, very true. Plans can be customized to the employer. Still, some BCBS companies are nonprofit whereas others are for-profit. All of UHC plans are for-profit (unless they’re just administering a plan for a union or something…). I know that’s a complicated term, but my point is that BCBS of Alabama is quite literally a different company than Blue Shield of California. The benefits for each UHC plan are different, but the claims are likely to be processed in the exact same place with similar procedures (even though the benefits themselves might be different).
The whole system is very…complicated…and not transparent. As a scientist I am always suspect of systems that are overly complicated and not transparent…
Boy, oh boy, I learned that one last year. I had been double insured (for which I was grateful). I had two different BCBS plans. I dropped one of them in 2018. The administrative nightmare that entailed in order to get claims paid was pretty eye-opening. I called the BCBS that I kept, who had been denying all of my claims and all of my kids’ claims stating we had other primary coverage, and sat on the phone with them for probably a total of five hours over several months to get my other coverage deleted from their system. Each time they’d tell me that they’d have to put me on hold to call the other BCBS to verify the last date of coverage, then they’d come back on the phone and say that they could not get a hold of that BCBS bc the phone number is disconnected. It’s good that I keep everything medical related, so I had the insurance cards still and provided the correct phone number to them myself. Otherwise this wasn’t getting fixed! It got to the point that each time I had to call and go through this again when another claim was denied, they’d say they were going to put me on hold to call the other BCBS to verify when my coverage ended, and I’d tell them, “The number you have listed in your system is no longer connected. I have the correct phone number. Would you like it?” Sometimes they’d take it, sometimes they’d insist on calling the disconnected phone number first, but they were always surprised that I knew this. Talking to them every month when I’d get a fresh batch of denied EOB’s gave me lots of practice.
This is just as crazy. There is no official “preferred” pump…this is totally up to the preferences of the diabetic interested in going to the pump. To us it was most definantly the preferred pump due to the fact that there were no tubes for it to get snagged and hung up everywhere. The pump is preferred by many smaller children for this very reason. Idiots.
I have only ever used BC/BS for our health insurance and I love it. We’ve never had a problem with Liam’s diabetes supplies…he uses Omnipod and the Dexcom G5. We pay almost no out of pocket every 90 days for Liam’s d-supplies through CVS.
Being double insured is a special kind of hell. You’d think having “more” coverage would be better. Nope. I spent literally years trying to sort out the bills from being double insured when I was in college and on both the school’s insurance and my mom’s “catastrophic care” plan. What a nightmare.