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.
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