Saturday, February 4, 2017

They want diabetics to do what?!?

If you have any close friends who are type 1, you must know that diabetics are hoarders of medical supplies. They may not be hoarders in any other aspect of their lives, but, to a type 1 diabetic, a stocked cabinet full of sensors, pump supplies, test strips, lancets, batteries, etc... is a source of comfort. We aren't (all) trying to screw over the insurance companies, we just want to have enough supplies on-hand to feel like we're not going to die.

Let me be clear: these supplies are necessary to live. I would have to check into a hospital if I didn't have access to an insulin pod for even one day.

Apparently, insurance companies (mine, at least) have implemented a rule that the patient has to be down to less than 10 days' worth of supplies before reordering. WHAT DIABETIC IS COMFORTABLE WITH THAT FEW SUPPLIES?

While I understand the rule--they are trying to cut down on waste and hoarding--I'll give you a few reasons why the rule is stupid.

1. It often takes a few days to get new supplies for unforeseen circumstances, such as needing a new form filled out by your doctor (pre-authorization, medical necessity, etc), a prescription renewal, or some other bureaucratic snafu. To give you an idea, a medical necessity form is something my doctor has to fill out to verify that yes, indeed, Laura is still diabetic.

2. People travel. If you are going somewhere for 3 weeks, you need to bring plenty of supplies with you and not be out of them when you return!

3. It would give me heart palpitations to have to wait until there is ONE sensor left in my closet before I can order more (one sensor = 7 days). Besides, I'M THE ONE USING MY SENSORS FOR TWO WEEKS AT A TIME SO I NEVER RUN OUT. And that's my right. Insurance still has to cover me for one every week.

4. I can never feel secure that I know where my next bottle of insulin is coming from. Especially with an Obamacare repeal on the horizon, I don't feel confident that my supplies will be available and covered because of all of the paperwork and logistical hassle involved in getting supplies when something goes wrong. I don't trust insurance companies I have enough experience with insurance companies to know that they are capable of some really unsavory practices, like recategorizing pump supplies to fall under "prescriptions" so they can put an absurd annual cap on them, leaving the patient high and dry.

Dear insurance companies,
It is bad policy to put patients in situations that they are deeply uncomfortable with, and in which they are most likely to lie for survival.

Lastly, I'd like to share this second-hand story I heard at the medical supply store.

A nice diabetic lady, 77, type 1 for 50+ years, is sitting at home when she hears a knock at her door. Being the nice lady she is, she opens it.

A sharply dressed woman stands at her doorstep. "I'm from the insurance company," she explains. "Can I come in?"

"Sure," says the nice old diabetic lady. They sit down on the couch in the living room. The insurance woman asks a few questions about the lady and her diabetes. Then, she asks if she can look in her fridge to see how much insulin she has in stock. SHE STRAIGHT UP ASKS TO CHECK HOW MUCH INSULIN THE NICE OLD LADY HAD IN HER FRIDGE. 

"I think it's time for you to leave," says the lady, in her most polite voice.

Moral: Never let the insurance company into your house.

Monday, November 21, 2016

Please Don't Make Me Go Back to Pre-Obamacare!

Great. Now I'm forced to write this stupid post because of stupid Donald Trump's stupid victory.

I think I'll start this post off with a story about how lame and ill-informed anti-Obamacare people are. I was in Washington, DC for a job interview, and I happened upon an anti-Obamacare rally. So I decided to infiltrate and ask some questions of the demonstrators, with their signs talkin' bout constitutional rights being violated and all that.

One middle-aged white guy (surprise surprise!) that I engaged got to hear a bit of my story. "Without Obamacare, I'd most likely be totally broke, if not dead," I told him. "You don't look unhealthy," he responded. "Yeah, that's the thing, healthcare is more complicated than looking or not looking healthy."

Here are my worst stories from pre-Obamacare:

1. The time I couldn't get insurance in California in 2004/5 because I was working for a temp agency and no insurance company would cover me. I had landed a REALLY good job working at McGraw-Hill on various educational projects. I hadn't even graduated college yet, so it was a really amazing opportunity. Unfortunately, the temp agency that I was technically working for didn't offer benefits under a group plan, and they informed me that I would just have to get an individual plan. So I called. And called, and called. Kaiser, Blue Cross and Blue Shield, they all literally said, "We don't offer individual plans for someone with type 1 diabetes."

But it gets kind of worse. I went to the county health department and talked with a social worker there. I was in tears as she told me that there aren't any programs for a person my age (not under 18 or over 65) with no kids. She said I could go to the public health clinic and they would see me under some county program.

My experience there is that I couldn't see a doctor more frequently than every 3 months, including diabetes visits. I got 15 minutes MAX with the doctor. When I needed him to write me a prescription, HE LITERALLY WROTE "INSULIN" AND "TEST STRIPS" ON A PIECE OF PAPER. (In case you are wondering, this is a useless way to write a prescription.)

Lastly, and worstly, this county program would only allow me to use Regular and NPH insulin. If you know anything about insulin, this is the kind I was taking back in 1996, and insulin has gotten MUCH better since then (more fast-acting, fewer peaks and valleys). No self-respecting doctor would prescribe it today. Unsurprisingly, the program also considered the insulin pump, a device that had already been around for decades, to be "experimental."

2. The time I went to grad school at Brandeis and got on the university coverage that paid for my prescriptions through mid-February each year. This was actually really bad, if you understand anything about insurance policy.

In Massachusetts, if you don't have a job, you can still get insurance through the state-sponsored program. It is REALLY GOOD. I got to see a qualified endocrinologist at Mass General, all insulin was modern and paid for, and amazingly, all of my diabetes supplies, including pump supplies, were automatically delivered to my doorstep each month like clockwork.

I had moved to Massachusetts in January and was starting grad school in June. Filling that gap in coverage was much-needed. So you can imagine my dismay when I was being made to switch to the plan offered by Brandeis. Here's why it was so bad:

There was a yearly max on prescription benefits of $2,000. That wouldn't have been a problem if not for this: the plan had recategorized insulin pump supplies (reservoirs, tubing, etc) as prescription benefits. This is unprecedented. Every other plan I have ever know deems these supplies to be durable medical equipment (the same category as prosthetic limbs) and is usually covered 80-100%. They are really expensive supplies.

So, doing the calculation accounting for the life-saving prescriptions and supplies I needed, the coverage would have gotten me through mid-February of each year. From there on out, I would have had to pay for everything out of pocket (about $1150 each month). Luckily my program was only 15 months long, and I had hoarded enough supplies to (barely) get me through. Diabetics are hoarders for this very reason.

Here's my message to the Trump Administration and to Congress:

Without Obamacare, insurance companies will pull off sketchy shenanigans like I have described: they won't cover those vulnerable populations that need it most, and even if they do, they might recategorize supplies to their bottom line.

Tuesday, June 23, 2015

The best take on breastfeeding in public I've heard so far

In response to a PopSugar article called "Dear Breastfeeding Moms, Is It Really That Hard to Cover Up?" one facebook user shared this poignant response and social commentary (reposted with permission). A longer version can be found here.

First lesson: Lactation is an innate part of reproduction. Barring medical complication, lactation is the next step after delivery. At times induced (which is so awesome I can't even... But I digress) the point is, lactating may be innate, but nursing is not. Nursing is learned activity. Learned. Contrary to myth, women aren't born with the instinct to know exactly what to do. Mom and child are getting the hang of this together. Primates (that's us) require observation and exposure for continued success and sustained efforts. Normalizing is vital. Seeing nursing moms and children matter. It's empowering and necessary. The choice to cover should only be preference of mother/child. Never infringe on their comfort.

Second: Modesty deals with arbitrary sexist standards birthed from coverture. There is nothing indecent about feeding a child. If you see a child nursing and modesty comes to mind, the issue is yours. And sure, we sometimes view breasts sexually. Welcome to the amazing world of a human body. Where we use our mouths and hands sexually too. I certainly hope you aren't thinking of those as sexual when kissing and holding a child. Think about it.

Third: Those of you asking for your discomfort to be respected, pay attention: My rights to nurse my child without cover DO outweigh your nonexistent right to not be offended. This is fact of law. You hold no such right. The public square is for the public. There are more than enough offenses we all must tolerate, including bigoted, uneducated, ignorant ones. Alas. Learn the difference between what is a right under law and what isn't.

I'm a little confused why you think I ought to hold in high esteem the ignorant aversions of a stranger in regards to nursing? Of course I won't respect that kind of ignorance. That person's offense is not my business or issue. And I'm certainly not going to cater to it over the right of my child to eat without a cover over his face or the breast he is feeding from. Why would I? Why would you even expect me to?

Should we have respected the aversions people had to others drinking from the same fountain? Should we have said "oh, respect their bigotry, their opinion matters too". Of course not. Again: Of course not.

I am not going to respect the view that women and children be treated as second class citizens that are shamed under cover into hiding because an idiot has an aversion to seeing a human mammal feed from a human mammary gland. Never.

And quite frankly, you shouldn't either.

Fourth: Images are empowering. They matter.

We live in an age where rants of TMI is the norm. We post pictures of our pets, our food, our shoes and yes, we share images of our families too. But when women share photographs of the moments they share nursing their children, scorn rips defiant calling women exhibitionist. It shouldn't matter what motive a woman has, but if we needed a reason, there are plenty of them. The images are empowering to many who are looking. They normalize breastfeeding as just another memorable moment a parent is having. And they encourage those who don't understand why critics didn't just keep scrolling.

Fifth: Human mammals require milk beyond infancy. Milk is a developmental requirement custom to species. Jaws alter, cheek fat diminishes, milk teeth drop, mammals wean. Until then, it's nonsense to suggest there would be anything weird about a human mammal expressing human milk from human mammary glands. What's weird is that we'd drink milk from another species after the wean. But alas, cheese. The age of weaning is a spectrum, not an arbitrary line. And telling my child he is weird because your child didn't nurse through those years is absurd.

If you're concerned about children being exposed, perhaps your answer is to teach them anatomy.

Monday, June 22, 2015

Bed-sharing: What your pediatrician won't tell you

Here's how the typical American story goes: Mom and dad take baby home. When nighttime rolls around, they put baby in his crib and head to their own bed. Baby gets hungry some time later and starts stirring. He starts smacking his lips, moving his head around looking for mommy's breast. He doesn't find it and starts to wail. This pulls mom (and dad) out of sleep, and mom drags herself to go pick baby up and try not to fall asleep as she feeds him. She will repeat this several times a night for months.

What ends up happening is that moms will fall asleep with the baby in her arms on the couch, in the glider, or in her bed. This can be dangerous if the baby slips out of her arms into soft couch cushions. But there is an alternative. Safe bedsharing, or as this article calls it, "smart bedsharing." I'm convinced that if you took out all of the unintentional bedsharing (any instance of falling asleep with baby in an unplanned, unprepared way), the data would show that intentional bedsharing is as safe as "safe sleep" (ie: putting the baby on his back in an obstacle-free separate space).  

I had already made the decision to bedshare with my newborn daughter by the third day she was home. Like most new parents, I was under the impression that the baby has to be in her own space. I tried to put her down, but she wouldn't cooperate. She simply slept best on me. For the first two nights, I slept on the couch the whole night with her on my chest. (Read: very dangerous!)

Then I hired a post-partum doula. She, of course, would not advise me to bedshare. I'm pretty sure it's a liability issue. Nobody will advise you to do it. Yet, every parent I talk to says that they bedshare(d) with their infants, whether or not they intended to. Many sheepishly admit they did it, adding that it's inevitable.

If bedsharing is inevitable, then can we please talk openly about how to do it safely and its benefits? And while we are being real, let's admit to ourselves, collectively, that far more infants die in car crashes from sleep-deprived parents on the road than die in bedsharing accidents? Yet, we aren't really telling parents to stay off the road.

I'll start by saying what I love about bedsharing:

1. It helps establish milk supply. With the baby next to me or sleeping on me, I get plenty of skin-to-skin contact with her. This helped to establish my milk supply in those early days.

2. Significantly improved sleep. I wake up when she starts to get hungry, rather than waiting for her to be all-out crying. This means that everyone gets better sleep -- mom, dad, and baby (and any others within earshot).

3. Baby gets comfort from sleeping next to mom. She also gets cues from mom, such as regular breathing.

4. Varied sleeping positions. After she nurses, I'll position her on my chest or on my stomach so that she can be on an incline after feeding -- helping her get burps out. This allows her and me to get right back to sleep without the discomfort of bubbles in her belly. 

5. Both mom and baby love snuggling. This is a scientific fact.

In contrast, putting baby on her back in her own space results in poor sleep for everyone involved (at least in my family), more gas and discomfort, less skin-to-skin, no breathing benefits, and it's less fun for both mommy and baby. But it is reportedly the safest position to reduce SIDS and suffocation deaths.

Here's the truth: people will end up bedsharing. But if it is not recommended or talked about, then parents will not do it intentionally and thus not safely. I mentioned to our pediatrician that I was bedsharing with our daughter, and told her that I was fully aware that the recommendation was to put baby on her back in her own space, but that I had already looked into the matter and had come to a decision. This would have been a great opportunity for the doctor to educate me on making bedsharing as safe as possible. Instead, she went on and on about the guidelines for safe sleep, trying to talk me out of it.

Back to our doula: After recognizing that safe sleep guidelines all recommend back sleeping, she worked with with me to make the bedsharing environment safe. We inspected the mattresses in my home and determined the best one for baby (on the firmer side -- not the pillowtop one). We made the bed with a tight fit with jersey sheets. We pulled down the blanket to mid-bed. We chose a small pillow for me that would be placed under my head, but with my head at one end with the other end away from baby. We tried out several positions -- baby facing me, facing away, on chest, on stomach.

Guidelines for safe bedsharing:
  1. Mattress is firm. Pillowtop or memory foam mattresses should be avoided. Feel a crib mattress for comparison. 
  2. Fitted sheet is tightly tucked so that there are no folds. 
  3. Minimize blankets. I use the top sheet plus one blanket. 
  4. Keep blankets at waist level. You can wear a long-sleeved shirt for warmth up top (though you may want to wear a nursing top). 
  5. Place baby on her back. I also place the baby on her side facing me, but you will have to determine your level of comfort. 

Pretty in Pink: The real challenge for gender stereotypes

My daughter was born on the same day as the princess in England. We chuckled at the coincidence and promised our daughter that she would never be a princess. Instead, she would be free to make her own choices and pursue her own passions, whatever they may be. And she will certainly be able to dress however she pleases. When I was a little girl, I used to wear shirts with bugs or dinosaurs on them. While I recognize that my influence may not be stronger than the influence of her peers, I secretly hope that she will not be one of those pink-clad, princess-obsessed little girls who is endlessly fascinated with sparkles.

Lucky for me and parents like me, the feminist movement has brought us this: Princess Awesome. It is a clothing company that had wild success getting funded through Kickstarter. The HuffPo article headline read: Moms Launch Stereotype-Bashing Clothing Line That Challenges What It Means To Be 'Girly'. Full disclaimer: this project was started by a former colleague and I wish her great success. I do, however, challenge that it is "stereotype bashing." I think the prints are cute (flowers and ninjas, adorable!), but they are still, alas, dresses. And it is still, alas, called "Princess Awesome."

Our society is fully ready to accept little girls wearing dresses with ninjas and math symbols. What we aren't ready for is little boys wearing dresses and flowers.

My husband and I noticed this trend when opted to wait until our child's birth to discover her sex. We thought it was medically irrelevant during the pregnancy, and my siblings had all done the same with their first child. When we received presents, we noticed a curious thing: folks were willing to give outfits that were clearly meant for boys, but nobody would commit to giving a more traditionally "girly" outfit.

Why are we culturally okay with little girls wearing footballs and trucks, but we would never see a little boy in a frilly dress?

I found an online discussion in an online forum on BabyCenter, where all walks of life come together to discuss everything, and I mean everything, about babies. A user poses this question:

"Can anyone come up with a good reason why dressing your boy child (infant toddler or older) in pink, frilly, flowery cloths is not common practice?" She goes on to say that, while she considers herself to be free of gender biases, especially for infants, she doesn't think she could bring herself to dress a little boy in girly clothes.

Someone responds: "Pink is fine on boys if the clothes have the boy style to them. Flowers...not so much. It just doesn't jibe well for them. It's not biased just can't see a boy with a flowered shirt. And frilly on a boy? Nope can't do that either."

But this response doesn't really hold up.  For one, our perception that flowers and pink are girly is entirely cultural. There is nothing masculine about blue and feminine about pink, and not all cultures even share this view (read more here). For another, it's not even really possible to tell whether babies are male or female once they have a diaper on.

So here's my challenge to anyone who considers him or herself a feminist: Instead of lauding ideas such as dressing up girls in math-print dresses as progressive and "sterotype-bashing", let's really challenge what we are willing to accept. Ask yourself: would you put a dress on a little boy? If you saw a little boy in a pink tutu, what would you think?

I'll end with a story. A little boy wanted a princess-themed birthday party when he turned five. His parents didn't see any reason why they shouldn't oblige his wishes, so they did it. By the time he was seven (when I met him), he was so embarrassed about the party that he was unwilling to talk about it. That's what needs to change.

Wednesday, May 27, 2015

I can't beleive my insurance company is paying for all of this!

This is kind of the anti-post. I have to say that I haven't had much to complain write about since I've been on the University's staff health care plan. It's really quite good coverage, which I guess highlights the huge difference in quality of life that an insurance plan can impact.

I will complain about the state of maternity leave in this country in the next post (promise). 

Here's the latest: I'm now 3 weeks post-partum. My gorgeous sleeping baby is sleeping in the baby carrier strapped to me as I type this. Throughout the pregnancy, I was part of a few groups online for fellow type 1s who are pregnant or moms. There were some crazy stories about the absurd amount of money they had to pay up front to the OB department in order to receive care.

Several women report having to pay $2,000 to $4,000 for their OB care, which doesn't necessarily include all charges, such as lab work, specialists, etc. 

One woman reports, "We pay out of pocket up to $4k I think, then 20% of the next $1k then 0% (in-network). I believe that I'll be paying whatever the standard "high risk" CS delivery is but it's pretty confusing what's included."

Another says, "I had to pay my OB before week 28. 3,200 dollars [sic]... Not including [sic] pediatrician, hospital and anesthesiologist."

So you can imagine my anticipation when I received the hospital bill for my pregnancy. Wait for it... $14. That's it. The rest was covered. And if we are being accurate, the $14 was for two guest meals for my husband while we were in the hospital. I kept asking, during my 40 appointments over the 40 weeks of pregnancy, if I was going to see a bill. I thought that each OB visit qualified as a specialist visit and cost $30 copay. This would add up to $1200, which I was prepared for. 

So you can see how this surprised me, especially after getting unexpected bills quite frequently over the years. 

Good job, PremiereCare/University of Michigan. Now, if you could please work on maternity leave. 

Wednesday, March 18, 2015

MedEQUIP partially reedems itself; Dexcom comes down a peg

I blame my insurance for not being cool and amazing and doing all it can to make life easy for someone with a chronic illness. Let me explain. My insurance doesn't allow for automatic refills (ie: they just autosend you your supplies every three months). I was getting auto refills when on the AMAZING MASSHEALTH PLAN that will live on in my heart and mind as the single best plan I have ever been on. They checked the insurance every month and shipped me supplies if all checked out. The other time I had auto refills was on Kaiser. They did NOT check my coverage for changes before shipping the supplies, and I ended up with a $780 bill (of course I disputed it and WON, because I am the dispute mistress!).

So this insurance plan, which is amazing in almost every way--trust me, I read through the Benefits document front to back, doesn't allow for automatic refills. They require that you call the company (or the company calls you, before shipping out the supplies. This would be fine if the company did it (they are, after all, making money off of this service). I'm less likely to remember to refill my supplies on a regular basis and end up running out and going without a sensor, or worse, without pump supplies, until the new supplies arrive. I'm sure this is why the insurance company does it: to save money when people like me forget to refill regularly.

I was SO FRUSTRATED with MedEQUIP for not calling me when my supplies were up for refill. It happened many times, and they always CLAIMED that they did call me. Uh, in that case, there would be a missed call on my phone, and anyways don't just call once!

Pro tip: Type 1 diabetes DOES NOT GO AWAY. I will always need insulin and supplies. Why the eff do I have to continually deal with refills? There should be an exception when it comes to chronic illnesses.

Anywho, I went through this whole thing where I switched my CGM supplies ordering to Dexcom. They assured me that they would call me every 3 months to get my refill authorization. They have a vested interest in getting more products out the door, right?

I trusted them, but ONCE AGAIN found myself out of sensors, right before heading to Boston for a long weekend. This was not going to be good. I called Dexcom to ask "What the hell?" and the ordering department told me, "Oh, no, we don't call customers to refill orders. We have a lot of customers! We do have an auto-refill program."

SO, who did I have to turn to for last-minute sensors? That's right, MedEQUIP. I called and begged them to refill my sensors right away, as I was heading to the airport and had literally 15 minutes to spare. They totally came through! I swung by the office and grabbed the sensors, and made it in time for my flight. Still, I will stick with Dexcom, just knowing that I will have to call my sensor order in every three months (MedEQUIP would make me do it every month). Dexcom also sent me two free sensors to make up for the loss in my overflow. But, I will no longer shake my fist angrily every time I drive by the MedEQUIP office.