Choosing New Health Insurance


We have spent hours this month investigating our health insurance options.

Since my husband began working at his current company 12 years ago we've had the same insurance. Until now, his company contracted with one insurance company, offering 3-4 plan levels each year. When he began employment there, we chose a plan with a lower deductible, lower coinsurance costs and a lower out-of-pocket maximum. And, of course, a higher monthly price. The per paycheck cost and copays went up a few times, but the coverage remained essentially the same. We glanced at open enrollment paperwork every year, but never considered changing.

This year the company rolled out a completely new system, with choices!!! There are now plans available from 3 different insurance companies, so that, including the various levels of coverage, there were a total of 15 options to consider. Fifteen.

The idea is that each contracted insurance company offers 3-4 levels of plans. The levels are equivalent across insurers. so, for example, the 'gold plan' from each insurance company includes a $20 primary care visit copay, 80% coverage for hospitalization, and $8 monthly copays for tier 1 medicines.

Speaking of pharmacy benefits, also new is that those will now be through the health insurer we choose. For several years now, the employer has contracted with Caremark for drug benefits instead of them coming through the health insurer. And the coverage was excellent. Now we have to factor coverage for insulin, test strips, and other family members' medicines into the health insurance choice.

Our initial instinct was to look into the plans from our current insurer. The devil you know is better than the devil you don't, right? There's a plan with coverage similar to what we have now. We double checked some things, like making sure the deductible was about the same and that the coverage for pump supplies seemed equivalent. We knew our physicians probably participated but we double checked the key ones to be sure they were in this particular plan. Things looked good.

Problem was: that particular 'gold' plan costs about $5000 more per year than one offered through a different insurance company. For a few hundred or so per year I might have stuck with my 'devil you know...' philosophy and bit the bullet. For $5000 we were back to the drawing board.

And it looks like we're rolling the dice and trying a new insurance company this year.

Our doctors all participate. We'll pay more for insulin and supplies, but not anywhere near $5000 more. Humalog is the insulin of choice, with our current Novolog not covered on any tier of the formulary.  I'm worried that I'm unfamiliar with the culture and mechanics of this company, diabetes-wise, and that there will be unpleasant surprises. There will be lots of things to try to get covered this year, with an inevitable switch away from Animas supplies and a possible switch in CGM sensors as well.

But on paper it looks reasonable enough to try in order to save thousands of dollars. I'll let you know how it goes...

One Last Story For November


Once upon a time there was a girl with diabetes who survived the whole month of November!

She ate some leftover Halloween candy but not too much.

She took an airplane trip to Florida where she celebrated her 16th birthday in the Wizarding World of Harry Potter. In Orlando she figured out how to bolus insulin to cover Butterbeer. She ate at restaurants and guessed the carbohydrate content of every meal, sometimes more successfully than others.

She had some long, busy days in November, including one when she ate dinner in the car on the way from a piano lesson to jazz band rehearsal. And another when she took two difficult and stressful tests.

She had a couple fun but out-of-the-ordinary evenings, like one which found her eating Nutella pancakes at a diner at 10 p.m. after working backstage for the school play. And another spent at the last Friday night football game of the marching band season, when she ate dinner on a school bus before spending 3 hours playing the clarinet in the freezing cold.

She thoroughly enjoyed Thanksgiving dinner, especially the stuffing, the cranberry bread, and the pumpkin pie. And the turkey sandwiches with cranberry sauce on white bread the next day. And Thanksgiving dinner round 2 (a.k.a. leftovers) on Saturday.

All through November, she checked her blood sugar, changed her pump sites, used her Dexcom, explained her diabetes needs to TSA agents and teachers, carried her supply bag wherever she went, counted her carbohydrates, corrected her highs and drank juice boxes for her lows. But those aren't the parts of November she'll remember.



Gringotts

One last story from our Universal Studios vacation:

We arrived at Gringotts, the goblin-operated bank frequented by the characters in Harry Potter. We stored our belongings in the lockers provided. No bags were permitted on the ride. Before a similar ride that morning we'd stuffed our pockets with airheads candy before stashing the rest of the supplies in the locker. This time we forgot.

Ten minutes into what was reported to be a 35 minute line to board the ride, the Dexcom alarmed.

"70 with a down arrow," my daughter reported. I had one airhead left in my pocket from the morning, which I handed over.

Three minutes later, the Dexcom alarmed again.

"It's double down now and says I'm 55."

"Do you feel low?"

"Yeah- I can't wait here."

There was a staff member nearby.

"My daughter is having a medical issue," my husband explained." What's the best way to exit?"

"Just walk up this ramp and you'll get out."

"Is there any way we can skip some of the line when we come back- it'll be about 10 minutes we think."

"Yes- absolutely- just tell the person at the entrance that Maya said you can come in through the express pass entrance. It shouldn't be a problem."

"Awesome- thank you so much."

So we went out and emptied our locker. We sat on the ground near a statue of a goblin holding a stack of gold while my daughter checked with her glucometer (55) and drank a juice.

We waited there a few minutes, people-watching.

"You feeling a little better?"

"Yeah- I'm definitely coming up."

A recheck showed 68. She ate another airhead for good measure, and we stuffed our pockets full of them before getting another locker.

The staff member at the entrance allowed our reentry through the express line, and with an elapsed time of under 15 minutes, we were soon standing next to the people who had been ahead of us in line before we exited.

The ride was great.

It's November...Diabetes Awareness Month! My plan for this month involves stories. Simple, everyday, real-life stories about living with diabetes. I plan to tell them here as narratives, like this one, just snippets of a day with diabetes, and I plan to tell them, or stories like them, more often in the 'real world' this month when friends ask, 'How's it going,' or relatives ask what I've been up to.  

A Security Story


As we arrived at the airport security gate on our way to Florida, my daughter disconnected her pump. "This needs to be visually inspected. It can't go through any of the scanners," she informed the TSA agent.

"That's what you'd like to do?" was the reply.

"Yes, please."

We walked through the body scanner and met the agent on the other side. We stood near him as he swabbed the pump to check for explosives and then returned it to my daughter.

Meanwhile I watched our toiletries and my carry-on bag slide into the 'to be inspected' holding area instead of continuing along the conveyor belt to be retrieved.

The first thing I was asked about was the Frio insulin cooling case.

 
 
"It's a gel cooler for insulin," I explained. "It has a vial of insulin and an insulin pen in it." The TSA agent handed it back, satisfied with the answer.

He still had my large backpack. "Anything in here you can think of that would have caused this to be pulled aside?"

"Um- it's got lots of diabetes supplies...syringes, insulin pump infusion sets, glucometers...I'm not sure what might have caused the concern."

So the TSA agent, who was very nice, rummaged through the bag, pulling out every make-up case and Ziploc bag, methodically opening and examining them one at a time. When those were all on the metal table and the only things left in the bag were books and a few other obviously safe items, he sent the backpack through the x-ray machine again.

"Okay- you're good to go," he said upon his return.

I observed the collection of items spread around the metal table, all of which needed to be fit back into the backpack in a way that would enable us to access the important ones during our flight, and stifled a laugh.

"Easy for me to say," the TSA agent said with a friendly smile as we started to repack.

It's November...Diabetes Awareness Month! My plan for this month involves stories. Simple, everyday, real-life stories about living with diabetes. I plan to tell them here as narratives, like this one, just snippets of a day with diabetes, and I plan to tell them, or stories like them, more often in the 'real world' this month when friends ask, 'How's it going,' or relatives ask what I've been up to.  

A Test Strip Story for World Diabetes Day

 
"Hey look- it's a test strip. It's not the kind I use."
 
 
This is a zoomed-in shot, and cropped. The test strip was virtually hidden in the sidewalk crack at the busy amusement park. Yet it caught my daughter's eye.
 
Finding a test strip "in the wild" meant that another person with diabetes had been there.

Whose was it? Was its user still around? Did the blood sugar it recorded require a $4 soda from the snack stand or a break from the rides? Was the person local or travelling? Type 1 or Type 2? Newly diagnosed or an old pro? Comfortable with diabetes care on the run or not?

We had a distinct curiosity about, and sense of kinship with, whoever dropped that strip.

Other people with diabetes, even complete strangers, hold a special place in our hearts.

The same sense of connection fuels my interest in World Diabetes Day. There are millions of people around the globe living millions of very different kinds of diabetes lives. But they're all living them because Dr. Frederick Banting, born 126 years ago today, discovered and bottled insulin.

What, I wonder, are their struggles? Successes? Stories?

Do they think about being part of a global diabetes community, and if so does it give them the same sense of hope it gives us?


It's November...Diabetes Awareness Month! My plan for this month involves stories. Simple, everyday, real-life stories about living with diabetes. I plan to tell them here as narratives, like this one, just snippets of a day with diabetes, and I plan to tell them, or stories like them, more often in the 'real world' this month when friends ask, 'How's it going,' or relatives ask what I've been up to.  


 
 

Vacation is For Fun

 
We accomplished all of our 'must-do's' on our visit to Universal Studios Orlando for my daughter's 16th birthday.
 
She used a wand to cast spells around Diagon Alley and Hogsmeade.
 
We took a wild ride through Gringotts bank.
 
After touring Hogwarts' interior, we experienced a high flying adventure over the castle and its environs.
 
We watched the Frog Choir and visited Olivander's Wand Shop.
 
We met the Knight Bus driver and the conductor of the Hogwarts Express.
 
She drank Butterbeer in Diagon Alley. Twice. She bought a bag of candy from Honeydukes in Hogsmeade Village.
 
 
 
 
She carried that bag with her and sampled Sherbet Lemons, Fizzing Whizzbees and Gummy Frogs throughout the day.
 
Her birthday dinner at Margaritaville included a virgin strawberry daiquiri and a complimentary red velvet cake dessert.
 
Did we count the carbohydrates in everything perfectly? No.
 
Did the walking make her blood sugar drop so that Fizzing Whizzbees became not only fun but medicinal? Absolutely.
 
Did she enjoy every moment, sip and morsel and live to tell the tale? Yup.


It's November...Diabetes Awareness Month! My plan for this month involves stories. Simple, everyday, real-life stories about living with diabetes. I plan to tell them here as narratives, like this one, just snippets of a day with diabetes, and I plan to tell them, or stories like them, more often in the 'real world' this month when friends ask, 'How's it going,' or relatives ask what I've been up to.  

A Letter


We received a letter in the mail the other day about a health insurance claim.

"The claim is on hold. It's important that we hear back from you within 45 days or we may not be able to process the claim," the letter read. Before this particular claim could be processed, our insurance company needed to know if my daughter was covered by any other health insurance plans.

I assumed that this claim was for insulin pump supplies or Dexcom sensors; for some very expensive diabetes-related claim.  Those seemed like the types of things which would suddenly flag her file requiring a double-check that nobody else might be in the position to foot the bill.

Nope. The big bill flagged for possible nonpayment? My daughter's flu shot.

I had a surprisingly quick phone "conversation" with an automated computer lady during which I was able confirm with her (it?) that my daughter has no other health insurance coverage. Now her five minute visit for a basic flu shot will be covered.

Presumably so will the next round of very expensive diabetes supplies.



It's November...Diabetes Awareness Month! My plan for this month involves stories. Simple, everyday, real-life stories about living with diabetes. I plan to tell them here as narratives, like this one, just snippets of a day with diabetes, and I plan to tell them, or stories like them, more often in the 'real world' this month when friends ask, 'How's it going,' or relatives ask what I've been up to.