Time for an update on my campaign to become an insulin pumper. Ouch. Painful experience dealing with Blue Shield, so far. Enormous amount of time spent explaining to perfect strangers — from the HR reps at my husband’s company to various “reimbursement managers” to a parade of officials at Blue Shield (forthwith to be referred to as ‘BS’) itself — why I ought to get medical coverage for a life-sustaining device that my doctors have been recommending for nearly four years. Very humbling.
“You see, since the day I was diagnosed, my doctors have been telling me that I’d be the perfect candidate for the pump. I’d get improved control of my diabetes, and therefore achieve better health outcomes in the long run. But it was ME who resisted. I didn’t want some contraption hanging off my body. But now there’s a new, wireless system that will help me control my diabetes without the tubing…”
My God, it’s not as if this were a cosmetic request! Do you think I’d wear a Pod full of liquid attached to my Bod if I didn’t absolutely have to? It’s not like I’m asking for a nose job here.
Some time back in November I got my first rejection, supposedly on the basis that “continuous glucose monitoring is still experimental therapy.” WtF? Do they not even know the difference between a glucose monitor and an insulin pump over there? Then I figured it was a simple mixup with the request for reimbursement that Dexcom (makers of the wireless CGM system I’m now using only occasionally) had placed on my behalf months ago; I had long since given up on seeing any of that money again.
Got my endo to contact the Medical Reviewer over at BS to clear that up, but my doctor was told that wasn’t the real reason for rejection at all: it was a cost-effectiveness issue, after all. Hmm, pump to prevent outrageously expensive complications of diabetes too expensive for them in the short-term? We’ve all heard that story before.
Despite the fact that at least a dozen other patients in California have managed to secure BS coverage for the OmniPod, the reviewer assigned to my case was (is?) still under the false impression that traditional pumps are more cost-effective for the health plan. Insulet (makers of the OP) assure me that this is hogwash.
Nearly jumped out of my skin on Friday when I received a BS letter stating that I’d been approved for a “standard insulin pump.” But wait just a minute… what do they mean by “standard”?? Surely the careful employment of that term was meant to exclude the OmniPod…?
Seems so indeed. The Insulet liaison assures me that this letter — inexplicably — is probably meant to uphold the original denial. Aargh!!
OK, yes. I could purchase the unit on my own out of pocket. But my deep and wide experience haggling with health insurance providers tells me that once you’ve actually paid for something yourself, trying to get them to pay you back for it is like… well… pulling teeth, without anesthesia, over a period of several years. (I was still trying to reclaim the money for my first C-section after I’d recovered from my second one).
Not only that, but I’ve talked it over with my husband, and we agree: it might be all right for us to put up our own money to buy the OmniPod system, if it’s still considered so new as to be semi-experimental. BUT we need some assurance that the insulin pods will be covered going forward, as that will become my life-sustaining insulin source! Whether the insurance pays for insulin in cartridges that fit into an injection pen, or in pods that pump the stuff into me directly through my skin shouldn’t really be too much skin off their nose, ay?
** SIGH ** (That was a loud one) I once thought I might have my OmniPod by Christmas. Then I reset expectations to Valentine’s Day. Now it looks like President’s Day will be a stretch. Passover might be nice symbolism. Cross your pocked fingers for me, will you all?