I'm sorry, our company doesn't care about how this policy will affect you

Today my diabetes supply company told me that they wouldn't be able to send me my sensors, unless I was willing to pay outright for them.

Read: No more continuous blood sugar monitoring for you, missy, unless you are willing to shell out some $1500!

Some background information: My sensors are for my continuous glucose monitoring system; an amazing innovation that allows me to track my blood sugars every five minutes, and gives me important information about trends and fluctuations in sugar levels. In short, I have come to rely on it, along with countless other type 1 diabetics, and going off of it would be like going back to the days of bloodletting as an acceptable medical practice (okay, extremem analogy, but I feel REALLY STRONGLY about this).

So, back to the conversation with the person from Edgepark Medical Services, a diabetes supply company that has always been really great to me.

Her: "Edgepark no longer works with your insurance."

Me: "WHAT?!? I find it hard to believe that EdgePark would stop working with BlueCross BlueShield."

Her: "Edgepark no longer can service certain areas."

She went on to the explain that they would be happy to ship the supplies at full cost of $1,554 for the 3 months' worth of sensors, just one of the many prescriptions I rely on.

I tried digging deeper, only to find that she didn't know much else beyond that "the computer wouldn't let her" ship an order to my area. She revealed that the company no longer contracts with BlueCross BlueShield in Michigan, Arkansas, or Washington State. "They won't allow supplies to be shipped to those places," she said.

So what do Michigan, Arkansas and Washington State have in common? I'm not really sure yet. Having just finished 1Q84 by Murakami, I'm in a conspiracy frame of mind. Here's what I know:

Michigan is pushing through legislation to have BCBS play by the same rules as other insurance companies. Apparently, Michigan struck a deal with BCBS (pre-Affordable Care Act) that it would get out of paying taxes in exchange for covering everyone, regardless of health status. Now that all insurers will have to abide by those rules anyway, come Jan. 1, 2014, the Michigan legislature is pulling BCBS's special treatment away. Read the AP story. BCBS is poised to pay $100 million annually in new taxes, according to AP.

I couldn't really find much bad news for Arkansas, but there is something interesting. Arkansas seems to have struck a deal with BCBS to implement a program to make medical treatment more efficient.

"The cost-sharing program, which started [the week of October 5] and involves Medicaid and some of the state's largest private insurers, will determine if a provider reaches quality and cost targets based on historical models." (From MedPageToday) Apparently, doctors are being rewarded for staying within certain cost ranges (based on historical ranges) and denies reimbursements to those who exceed historical costs. (See my previous post about how rationing is inevitable whether or not we are operating in a private or public system.) It's possible that under this system, BCBS found that Edgepark's rates didn't fall within those parameters. (If that's the case, tsk-tsk, Edgepark. $1554 for 12 sensors???? They are plastic and a small strip of metal. It really can't be THAT much.)

Washington State... This seems to be a bigger question mark. Washington, Oregon, and other regional BCBS seems to have consolidated more than a decade ago to become Regence BlueCross BlueShield. Why would EdgePark discontinue working with Washington, but not Oregon and the entirety of Regence BCBS, which had been recently chided for dropping its lowest rate plan for individual coverage, while slimming what is covered in its plans and simultaneously raising premiums.So many questions are sparked by this phone call to Edgepark. I guess they didn't realize they were speaking to such an inquisitive person, otherwise she would not have disclosed so much. She did mention that they were trying to "work out a solution."I have tweeted Edgepark for some answers, as well as having inquired about the press contact for HGI Holdings, which is the company of Edgepark. We shall see...

*UPDATE: My friend/lawyer/former roommate Jonathan informs me that this is likely due to contract disputes. Thanks, J, for bringing down my whole conspiracy with mere logic! Still, my point stands: Insurance company policy changes may just be a blip in the screen for them, a hiccup in the flow of money. But for someone like me, it's a huge disruption in my life.

Rationed care: what it means for your weekend

January 1st represents a very hopeful day for me: it is the first day of my spankin' new, monstrosity of an institution, veritably good quality health coverage. Universities are renown for providing top-notch coverage for their staff, and I have the good fortune to latch onto Josh's care come January (yay, domestic partnership!).

Here are some things I have to look forward to:

• No lifetime maximum (Harvard Pilgrim plan through Brandeis--for grad students--had $100K lifetime max)
• Mental health benefits
• Low copays for doctor visits
• huge network of providers

Basically, all of the things one should expect from a reputable health plan; many people enjoy these norms. This plan, up until last year, was playing with offering diabetes care with no copays in order to encourage diabetics to more aggressively manage their illness. However, apparently the program had little effect and it died. Boohoo for me -- I would have gone on an insulin frenzy under this program. 

It's amazing to me that people are so protective over their private insurance and balk at the idea of a large-scale national health plan. In my experience, the more members the plan has, the higher quality it is. Say what you will about bureaucracy, I just plain trust the intent behind nationalized care. It's not about taking care away from you; it's about making sure that nobody is overly burdened with medical bills. Take Israel's program: They have a single payer--the government, paid by, yes, higher taxes--and have private companies (four of them) offer different plans that citizens can elect. Above and beyond the basic, paid-for-by-your-taxes plan, you can elect all kinds of other benefits that you have to pay for. But if you are on the basic plan, you cannot pay more than a certain amount of your own money per month (when I was there it was about $250). Once you hit that max, you do not pay anything over that. 

Is the care rationalized? Well, let's call it "medically necessary." Guess what? It's the exact same deal in private insurance. My continuous glucose monitoring system had to be deemed medically necessary before it was paid for by my private insurance plan. Same with my insulin pump. Furthermore, I found that MassHealth (shout out, M. Romney for pushing through that beautiful plan that is a model for the nation), everything seemed to be much more efficient, from my automated supply deliveries to cooperation among my various doctors. 

It shouldn't surprise any of you that I have been closely watching the continuing discussion over the Affordable Care Act (a.k.a Obamacare).  And I can't say that I am surprised that opposition to the plan remains a Republican talking point (even though it was a Republican idea in the first place).  But I do find it really ironic that the biggest point of discussion about the plan is the continued myth that the law invents so-called "death panels", namely committees of bureaucrats that would decide whether individuals can receive medical care.

Let's discuss this idea and what is really going on.

According to a hot-off-the-presses study, 46% of Americans think that the plan includes this kind of committee and less than 17% of Americans are confident that such a provision is not in the plan.

There is no such thing as unrationed care.  The costs of healthcare are simply too high for everyone to get coverage.  There has been ample evidence of this. And does anyone really think that we can pay for ALL of the care that everyone thinks they need? My dear father, the sweet old hypochondriac, is getting rationed care when his doctor tells him that, no, he doesn't have small pox and will not do a test for it. Perhaps we should all wean ourselves off of WebMD and actually listen to our doctors.

Perhaps the most shocking bit of the debate on Monday was the mention of death panels. Again. Didn't that idea die when somebody actually read the Affordable Care Act? (Have Republicans even read it yet?) Most unsustainable healthcare system ever.