Today I got a bill for $739.00 from an ambulance company. Yay! What fun! Always love an unexpected bill. What really amused me was the fact that it listed out the expenses:
Ambulance services: $739
Insurance adjustment: -$194.09
Insurance payment: $544.91
Insurance take back: -$544.91
Adjustment: $194.09
----------------------------------------
Please pay this amount: $739
Wait... So the insurance company paid this bill and then took it back?!?!? How is that OK?
Apparently, this happens ALL THE TIME. Insurance companies aren't very good at keeping up-to-date information.
I used to be on a COBRA plan through BlueCross/BlueShield (CareFirst--a DC-based franchise). According to BCBS policy, if the care is provided out of network, the provider has to bill the local BCBS. So, they billed Michigan BCBS.
Then, I switched to my partner's plan -- also BCBS, and a local Michigan plan. At the time of the service, I was on my partner's plan. So, how is it that a claim submitted to the local BCBS (albeit under the incorrect member number), wasn't checked for active and valid coverage?
Wait, isn't there something called "Coordination of Benefits?" From the name of that, it sounds like insurance companies will coordinate with one another to make sure you are covered. This would be especially easy if ALL of the coverage is within the same company.
Yeahhhhhh... they don't really mean that. It's like when a law is passed with a name that implies the opposite of what it actually does (read: No Child Left Behind). Coordination of Benefits would be better named "Makin' damn sure we don't pay fo' shit we don't have to."
One would think that BCBS could figure out that I'm covered under another plan with them.
IT GETS WORSE: I received a letter from the "Corporate Recovery Unit" telling me to repay them for $139 for services they covered after my coverage ended. This was a case where I went from my partner's plan to my own in the same damn plan. The best part is that they wrote: "If you have other coverage for the attached date(s) of service, please contact the provider/pharmacy where you received the service and ask them to bill the correct insurer and reimburse BCN." So... I should have them bill BCN to reimburse BCN for services paid for by BCN.
Awesome.
Monday, November 4, 2013
Tuesday, October 22, 2013
The UK thinks WHAT about American healthcare?!?!?!?
Holy shit.
I was just told that UK bureaucrats look to the US as an exemplar of privatized health insurance. We have a guest staying with us from across the pond who told me a bit about how to the power players in the British government are systematically cutting health benefits to the disabled and piecing apart the revered (in my mind at least) NHS to sell off to their cronies.
WHAT?!?!? Have they not been listening to a thing I have said?
Here's what is going on, as far as I can surmise from the press, but be warned that the spin on this seems to be excellent:
"It worked, in that it exposed a huge scam," the guest responds. Scam, you say? Let's talk about this "scam."
(This article from the Guardian is a great analysis on what's happening.)
Work and pensions secretary, Iain Duncan Smith, also claims that there was a huge scam under the surface-- claiming that a 30% increase in those on disability benefits over the past few decades is due to fraud and abuse.
The Department of Work and Pensions' own estimates put fraud at 0.5%, so where is this scam? Also, one can think of plenty of reasons--just off the top of one's head--why disability claims would go up 30% over the years.
One report shows a rise in verbal abuse towards disabled people. Yes, because that's what they need. People yelling at them. In addition to the disability that makes everyday life difficult at best. And now a French company is coming in and making really BAD assessments about who is fit for work.
"The work capability assessment, outsourced to Atos, a private healthcare organisation, has made it harder to qualify for the benefit, but the assessment process has been highly erratic, with thousands of patients with chronic, lifelong disabilities being wrongly found fit for work."
A lot of these decisions -- claiming that disabled people are fit for work -- have been appealed and overturned.
As the article points out, a lot of these people receiving Disability Living Allowance (often used to help get to and from work) are already living in poverty. Removing this allowance will plummet them further into poverty.
Here's my commentary:
This issue isn't black and white. Nobody can claim that it is. Some conditions are the result of unhealthy lifestyles, and some disabilities can happen to anyone at anytime. If we want to really cut down on the number of folks on disability claims, then let's promote healthy lifestyles. Hey, let's start with an assessment of the food industry--that dirty, irresponsible gang of unfeeling thugs. Let's reform health insurance to reward healthy choices.
What we shouldn't be doing is this: Cutting back on services that allow disabled people some ease and convenience in basic, everyday conveniences that the "abled" population takes for granted. Like getting around. Like being able to work. How can you claim that someone is "fit for work" when they have to spend 6 hours a day soaking and wrapping their feet because of complications of type 2 diabetes?
Instead of antagonizing this already vulnerable, yet incredibly resilient population, let's put this level of effort to eradicating obesity. There's your decrease in disability claims: help obese people get to a healthy weight range. Give them the tools to do so. Give them the support to do so. What if, instead of paying out a small pittance of disability living allowance throughout their lifetime, there is a focused effort on health education, support programs, assistance with making healthy choices, FREE EXERCISE?
Crazy, I know, but it would work. Free Herbalife shakes for all.
I was just told that UK bureaucrats look to the US as an exemplar of privatized health insurance. We have a guest staying with us from across the pond who told me a bit about how to the power players in the British government are systematically cutting health benefits to the disabled and piecing apart the revered (in my mind at least) NHS to sell off to their cronies.
WHAT?!?!? Have they not been listening to a thing I have said?
Here's what is going on, as far as I can surmise from the press, but be warned that the spin on this seems to be excellent:
- The UK has hired a French company, Atos, to review disability benefits in hopes of dropping a half million recipients of disability benefits--such as Personal Independence Payments, Disability Living Allowance,
- Mobility services will be cut -- leaving disabled folks without a reasonable and affordable means to get around, including to and from work
- More than a half million disabled people will be reassessed, and some 330,000 of them can expect to see benefits cuts or reduced
"It worked, in that it exposed a huge scam," the guest responds. Scam, you say? Let's talk about this "scam."
(This article from the Guardian is a great analysis on what's happening.)
Work and pensions secretary, Iain Duncan Smith, also claims that there was a huge scam under the surface-- claiming that a 30% increase in those on disability benefits over the past few decades is due to fraud and abuse.
The Department of Work and Pensions' own estimates put fraud at 0.5%, so where is this scam? Also, one can think of plenty of reasons--just off the top of one's head--why disability claims would go up 30% over the years.
- Rise in obesity (thanks, America, for leading the pack on this one)
- People living longer (the UK allowed for people to continue receiving disability claims past retirement age in 1992, causing a sharp rise in disability claims)
- There has been broader (and better) recognition of conditions
One report shows a rise in verbal abuse towards disabled people. Yes, because that's what they need. People yelling at them. In addition to the disability that makes everyday life difficult at best. And now a French company is coming in and making really BAD assessments about who is fit for work.
"The work capability assessment, outsourced to Atos, a private healthcare organisation, has made it harder to qualify for the benefit, but the assessment process has been highly erratic, with thousands of patients with chronic, lifelong disabilities being wrongly found fit for work."
A lot of these decisions -- claiming that disabled people are fit for work -- have been appealed and overturned.
As the article points out, a lot of these people receiving Disability Living Allowance (often used to help get to and from work) are already living in poverty. Removing this allowance will plummet them further into poverty.
Here's my commentary:
This issue isn't black and white. Nobody can claim that it is. Some conditions are the result of unhealthy lifestyles, and some disabilities can happen to anyone at anytime. If we want to really cut down on the number of folks on disability claims, then let's promote healthy lifestyles. Hey, let's start with an assessment of the food industry--that dirty, irresponsible gang of unfeeling thugs. Let's reform health insurance to reward healthy choices.
What we shouldn't be doing is this: Cutting back on services that allow disabled people some ease and convenience in basic, everyday conveniences that the "abled" population takes for granted. Like getting around. Like being able to work. How can you claim that someone is "fit for work" when they have to spend 6 hours a day soaking and wrapping their feet because of complications of type 2 diabetes?
Instead of antagonizing this already vulnerable, yet incredibly resilient population, let's put this level of effort to eradicating obesity. There's your decrease in disability claims: help obese people get to a healthy weight range. Give them the tools to do so. Give them the support to do so. What if, instead of paying out a small pittance of disability living allowance throughout their lifetime, there is a focused effort on health education, support programs, assistance with making healthy choices, FREE EXERCISE?
Crazy, I know, but it would work. Free Herbalife shakes for all.
Wednesday, October 9, 2013
Insurance co. forced to be a good puppy by big, bad university
I post far too much about insurance companies sucking (in case you haven't noticed, it's my Carthusian). So I've decided to celebrate something my lovely insurance company did unprompted. See, I got married in June, changed my last name, and took a permanent position in late August at the university and went from my partner's plan to my own.
So, I went in for something on Sept. 16, two weeks after switching to my own plan. The provider (U-M health system) billed my old plan. I got an explanation of benefits that showed that I was responsible for the full amount because the claim was denied (duh, because my husband dropped me when I got my own plan).
S#*! Now I have another big medical bill--$1640 this time. I called in to the provider to explain the situation and to ask them to resubmit the claim under my new member number.
"It's already been taken care of," she told me. "We figured it out when the claim came back unpaid. You're all set."
Wow. Impressive. If only Edgepark Medical (grrrrrrrrr!!!) could learn a lesson from this.
Now, here's what's really going on and why it works: the University employs a large number of people (plus they cover grad students). They therefore have a lot of bargaining power and they have really good intentions -- to both reduce costs as much as is reasonable and to provide a high level of healthcare for its faculty and staff. Additionally, they run the best hospital (and 2nd biggest) in the state. Furreal. There have actually been a number of impressive benefits offerings out of the U: they have bargained a grace period for medical flexible spending, they are starting to offer all employees a base level disability insurance at no cost. The dental offerings aren't too shabby.
Here's an idea: if you have a large pool of people, and a well intentioned organization going to bat for them against the money-grubbing insurance companies, then, well, you might actually have a shot at getting good care for a reasonable price wheee the insurance company doesn't try to weasel it's way out of paying every little claim.
I'll add that Blue Cross in Michigan is a not-for-profit organization.
Large pool of folks + single payer system where the payer actually wants a healthy (read: productive) population + non-profit insurance company (incidentally, they only use 9% of premiums to cover overhead) = really happy Laura
So, I went in for something on Sept. 16, two weeks after switching to my own plan. The provider (U-M health system) billed my old plan. I got an explanation of benefits that showed that I was responsible for the full amount because the claim was denied (duh, because my husband dropped me when I got my own plan).
S#*! Now I have another big medical bill--$1640 this time. I called in to the provider to explain the situation and to ask them to resubmit the claim under my new member number.
"It's already been taken care of," she told me. "We figured it out when the claim came back unpaid. You're all set."
Wow. Impressive. If only Edgepark Medical (grrrrrrrrr!!!) could learn a lesson from this.
Now, here's what's really going on and why it works: the University employs a large number of people (plus they cover grad students). They therefore have a lot of bargaining power and they have really good intentions -- to both reduce costs as much as is reasonable and to provide a high level of healthcare for its faculty and staff. Additionally, they run the best hospital (and 2nd biggest) in the state. Furreal. There have actually been a number of impressive benefits offerings out of the U: they have bargained a grace period for medical flexible spending, they are starting to offer all employees a base level disability insurance at no cost. The dental offerings aren't too shabby.
Here's an idea: if you have a large pool of people, and a well intentioned organization going to bat for them against the money-grubbing insurance companies, then, well, you might actually have a shot at getting good care for a reasonable price wheee the insurance company doesn't try to weasel it's way out of paying every little claim.
I'll add that Blue Cross in Michigan is a not-for-profit organization.
Large pool of folks + single payer system where the payer actually wants a healthy (read: productive) population + non-profit insurance company (incidentally, they only use 9% of premiums to cover overhead) = really happy Laura
Monday, October 7, 2013
What is it they say about sausages and laws?
They say you don't want to see how either one is made. Well, I'd like
to add insurance policies, and well, pretty much insurance anything to the list.
I've been on a really great plan for the past 10 months -- thanks University of Michigan (and the gays! who paved the way for significant others to be covered on their non-spouse partner's plan). Each time a claim is processed, the insured member gets a copy of the Explanation of Benefits (EoB), which outlines the services rendered and if they were covered (and for how much). I'm the type of person to carefully go over each and every EoB; this is pretty much the only way to figure out what was charged, how much, and what was paid.
In looking over my EoBs, I noticed two things--one of which should be illegal, and the other is just really sneaky.
Let's look at an example, using real amounts, of what this would mean:
Amount charged (and amount paid):
Total amount actually paid = $1590 (leaving me with $0 to pay, except for copays, and some cushion room for other prescriptions, should I need them)
Just to get political for a minute: Is this what Republicans envision for our free market healthcare system? One in which insurance companies and healthcare providers continue to obscure and confound pricing? One in which the uninsured is completely taken advantage of?
When you look at the inflated prices that the uninsured are paying, does requiring people to get health insurance seem so bad? Perhaps when all are insured, these criminal practices will go away.
Done.
I've been on a really great plan for the past 10 months -- thanks University of Michigan (and the gays! who paved the way for significant others to be covered on their non-spouse partner's plan). Each time a claim is processed, the insured member gets a copy of the Explanation of Benefits (EoB), which outlines the services rendered and if they were covered (and for how much). I'm the type of person to carefully go over each and every EoB; this is pretty much the only way to figure out what was charged, how much, and what was paid.
In looking over my EoBs, I noticed two things--one of which should be illegal, and the other is just really sneaky.
- The discrepancy between what the provider attempts to charge and the price the insurance company actually pays is criminal. Case-in-point: Lancets (the little plastic pokey things that go in the lancet device in a blood glucose meter kit) are charged at $75. That's how much an uninsured person is charged. The insurance company has negotiated (strong-armed?) this price down to $5. The real cost of lancets remains obscure, but is probably somewhere around $10 if I had to guess.
- The insurance company uses the amount is was charged as the "amount covered." Remember, they didn't pay this amount; it's just what they were charged. Ie: "Amount covered: $75" when really they paid $5 for the thing. Disgusting.
Let's look at an example, using real amounts, of what this would mean:
Amount charged (and amount paid):
- Lancets: $75 (paid $5)
- Sensors: $1500 (paid $1100)
- Insulin: $768 (paid $485)
Total amount actually paid = $1590 (leaving me with $0 to pay, except for copays, and some cushion room for other prescriptions, should I need them)
Just to get political for a minute: Is this what Republicans envision for our free market healthcare system? One in which insurance companies and healthcare providers continue to obscure and confound pricing? One in which the uninsured is completely taken advantage of?
When you look at the inflated prices that the uninsured are paying, does requiring people to get health insurance seem so bad? Perhaps when all are insured, these criminal practices will go away.
Done.
Thursday, May 9, 2013
The obscurity of medical services pricing
I've often wondered about pricing in the healthcare industry. It is so obscure. I'm very grateful to NPR for exploring this issue recently on Planet Money's Hospital Prices, Revealed! (Sort of).
First, I'd like to recount my fun visit to the hospital on New Year's Eve, 2010 (through Jan 1, 2011). Well, I won't get into the details of WHY I ended up in the hospital (new CGM + too much wine = low blood sugar and friends calling 911).
I will talk about the time a $10,000 bill that made its way to my mailbox. To make a long story short, I ended up making the hospital audit its own bill and contested the claim with the insurance company along with a two-page narrative with exhibits A-H showing why I was right. In the end, they sent me an anticlimactic letter saying that my bill had been adjusted and guess how much I owed? $35 (the amount of the emergency room copay).
What I was astounded by was the pricing of the itemized bill. (Apparently you can get your hands on these if you submit and sign the right form.) Items such as:
"It's no secret that hospitals' list prices are ridiculously high and seemingly arbitrary."
It is a secret (to me, at least) why Americans are willing to put up with this racket.
First, I'd like to recount my fun visit to the hospital on New Year's Eve, 2010 (through Jan 1, 2011). Well, I won't get into the details of WHY I ended up in the hospital (new CGM + too much wine = low blood sugar and friends calling 911).
I will talk about the time a $10,000 bill that made its way to my mailbox. To make a long story short, I ended up making the hospital audit its own bill and contested the claim with the insurance company along with a two-page narrative with exhibits A-H showing why I was right. In the end, they sent me an anticlimactic letter saying that my bill had been adjusted and guess how much I owed? $35 (the amount of the emergency room copay).
What I was astounded by was the pricing of the itemized bill. (Apparently you can get your hands on these if you submit and sign the right form.) Items such as:
- Laboratory $78
- Unicyclin $109
- Emergency room $2151
- Observation room $1051
- IV start $314
- Physician fee $410
That "laboratory" fee of $78? That's for pricking my finger and testing my blood! Which, by the way, was vehemently against my wishes. I told them I preferred to test my own blood with my machine, but they insisted. The Unicyclin is for one pill of anti-naseau medication. IV start is the tubing for an IV. Just the tubing. The only reasonable charge I see up there is the Physician fee!
Now, when the whole thing was over, I looked at the EoB to see how much the insurance company actually paid for these services. $33 for the unicyclin (less $76 than the bill), $13 for the lab fee (less $65 than the bill). From the NPR article: "...private insurance companies negotiate their own rates with hospitals, and the rates bear little resemblance to the list price."
So, wait. Let me get this straight. If you were charging ME, a potentially poor and uninsured diabetic, it would be 3 to 5 times what you would charge the insurance?!?! WTF.
Insurance companies, hospitals, medical service providers: SHAME ON YOU. You are all so sketchy. Just be reasonable. Have a fair price. Stop engaging in this racket that bankrupts people and leaves them fat, sick, and/or dead. Have some goddamned decency.
"It's no secret that hospitals' list prices are ridiculously high and seemingly arbitrary."
It is a secret (to me, at least) why Americans are willing to put up with this racket.
"But your policy is going to kill me!"
OK, so the medical equipment supplier won't approve my plea to get the new Dexcom G4 system, and thus I will need to stay on the crappy old system for a bit. Fine. I understand that what I'm asking for is kind of nitpicky, and yes, I can chill out on my current CGM for the remaining two months it's under warranty. But I really want the new Dexcom G4 system! It's amazing. 30% more accurate. Twice the range. My God, I'm drooling over it!
Here's my beef: I just don't think that an industry that deals with the health of people should be set up so rigidly. There has been a strong theme, growing bolder each day, of hiding behind policies. Some of these policies make sense (like not covering a new CGM until the last one is out of warranty). Some make ZERO sense.
I was on Harvard Pilgrim healthcare through Brandeis University, where I went to grad school. This was one of the darkest times of my life as far as coverage goes. They reclassified insulin pump supplies (traditionally classified as durable medical equipment and covered at either 80% or 100%), and instead put them under "Prescriptions." You know, like medicine and whatnot. Then, they capped Prescriptions at $2,000/year. Mind you, after the actual prescriptions I needed (insulin, test strips), I wouldn't be able to get any pump supplies, let alone a new pump, should I need one.
I calculated out how this policy would affect me: I would be covered for about 2 months of my life-necessary medical supplies. READ: I would die after 2 months. I did everything I could to fight this. I spoke with managers. I spoke with Brandeis to let them know that I would die under this policy. NOBODY CARED. (Well, they cared, but still hid behind the policy.)
How did this end, you ask? I'm obviously not dead (this happened in 2010). Cuz I'm a hoarder!!!! Mwahhahahaha! All diabetics are. If we weren't, we would be totally screwed by these policies. I had enough pump supplies to power me through grad school and until I got real insurance.
I know Obamacare has made it so insurance companies can no longer categorically deny me coverage as a type 1 diabetic (this has happened, over, and over, and over). But this is where I say "more regulation!" You CANNOT consider that real coverage. It's fake coverage. Oh, and I didn't even mention the $100K lifetime cap!
Here's my beef: I just don't think that an industry that deals with the health of people should be set up so rigidly. There has been a strong theme, growing bolder each day, of hiding behind policies. Some of these policies make sense (like not covering a new CGM until the last one is out of warranty). Some make ZERO sense.
I was on Harvard Pilgrim healthcare through Brandeis University, where I went to grad school. This was one of the darkest times of my life as far as coverage goes. They reclassified insulin pump supplies (traditionally classified as durable medical equipment and covered at either 80% or 100%), and instead put them under "Prescriptions." You know, like medicine and whatnot. Then, they capped Prescriptions at $2,000/year. Mind you, after the actual prescriptions I needed (insulin, test strips), I wouldn't be able to get any pump supplies, let alone a new pump, should I need one.
I calculated out how this policy would affect me: I would be covered for about 2 months of my life-necessary medical supplies. READ: I would die after 2 months. I did everything I could to fight this. I spoke with managers. I spoke with Brandeis to let them know that I would die under this policy. NOBODY CARED. (Well, they cared, but still hid behind the policy.)
How did this end, you ask? I'm obviously not dead (this happened in 2010). Cuz I'm a hoarder!!!! Mwahhahahaha! All diabetics are. If we weren't, we would be totally screwed by these policies. I had enough pump supplies to power me through grad school and until I got real insurance.
I know Obamacare has made it so insurance companies can no longer categorically deny me coverage as a type 1 diabetic (this has happened, over, and over, and over). But this is where I say "more regulation!" You CANNOT consider that real coverage. It's fake coverage. Oh, and I didn't even mention the $100K lifetime cap!
The university system wins it! Second only to Universal
I thought that teachers had good health coverage. That was until I looked into how good professors have it. The University of Michigan health coverage for faculty is crazy good, and even better if you have type 1 diabetes. They have a diabetes program that eliminates copayments for most of the prescriptions: insulin, syringes, test strips. And other related prescriptions that are not necessary but can help with management, such as Symlin or Glucagon, are on a copayment reduction schedule which means they cost as low as $15 for 3 months' worth.
They even tried out a program to see if eliminating ALL copays for diabetes-related stuff (Dr visits, Rxs) would encourage type 2 diabetics to take better care of themselves. It didn't. That was a year before I got on UMPC.
However, it is hugely bureaucratic. Partly because it has to be in order to cut down on fraud or unnecessary services, and mostly because it's managing so many moving parts.
Let me illustrate: There is something called "Coordination of Benefits." Sounds nice, right? No, it's not. It's more of a racket among insurance companies to make sure that nobody has to pay for something that another insurance company has paid for (OK, fine, it's mostly to protect insurers from fraud, but also kind of a racket.) I recently learned about this when I tried to lie, cheat, and steal my way to the new Dexcom G4 system, which is leaps and bounds better than the old SEVEN Plus system. Twice the range! 30% more accurate! Who wouldn't want that?
Well, when they go the request from my doctor, they actually called the manufacturer and demanded my records (wait, I thought that was against HIPPA). When they found out that my current CGM (Continuous Glucose Monitor) is still under warranty for another two months, they denied my claim. Oh well. Guess I'll just have to wait the 2 months.
BUT, my larger point here is that in the universal system THIS DOESN'T HAPPEN. There's no such thing as coordination of benefits. It's all already coordinated. I'm not saying universal coverage is without fault, but image, just imagine, a system that cuts out all that waste and extra manpower and paperwork?!?!? It would be so efficient.
Sigh.
They even tried out a program to see if eliminating ALL copays for diabetes-related stuff (Dr visits, Rxs) would encourage type 2 diabetics to take better care of themselves. It didn't. That was a year before I got on UMPC.
However, it is hugely bureaucratic. Partly because it has to be in order to cut down on fraud or unnecessary services, and mostly because it's managing so many moving parts.
Let me illustrate: There is something called "Coordination of Benefits." Sounds nice, right? No, it's not. It's more of a racket among insurance companies to make sure that nobody has to pay for something that another insurance company has paid for (OK, fine, it's mostly to protect insurers from fraud, but also kind of a racket.) I recently learned about this when I tried to lie, cheat, and steal my way to the new Dexcom G4 system, which is leaps and bounds better than the old SEVEN Plus system. Twice the range! 30% more accurate! Who wouldn't want that?Well, when they go the request from my doctor, they actually called the manufacturer and demanded my records (wait, I thought that was against HIPPA). When they found out that my current CGM (Continuous Glucose Monitor) is still under warranty for another two months, they denied my claim. Oh well. Guess I'll just have to wait the 2 months.
BUT, my larger point here is that in the universal system THIS DOESN'T HAPPEN. There's no such thing as coordination of benefits. It's all already coordinated. I'm not saying universal coverage is without fault, but image, just imagine, a system that cuts out all that waste and extra manpower and paperwork?!?!? It would be so efficient.
Sigh.
Monday, May 6, 2013
We are insurance. We do what we want.
What kills me about the entire insurance industry is that THEY were the ones who decided to get into the business. They bet we won't get sick, we bet that we will get sick, and thus we have this incredibly convoluted and opaque industry where they make tons of money, America has never been sicker, and a diabetic can't get a break.
So, when their bet goes awry, instead of taking it like a champ, and saying, "oh, blistering barnacles, we were wrong, here's your coverage, old chap," they try to weasel, lie, cheat, steal and red tape their way out of paying.
It's so disgusting.
The latest ickiness is UMPremierCare: a representative from Dexcom (manufacturer of continuous glucose monitoring systems) told me that PremierCare has the strictest policies on obtaining medical devices. Mind you, they have NEVER paid for a CGM for me. The last one I got was last July when I was still on CareFirst. They make Dexcom send them warranty reports and serial numbers for any previous CGM, whether or not it was covered by UMPremierCare or not. Let me illustrate this for you:
This especially sucks when one's CGM has been lost in a field, and one's blood sugars have not been under such tight control ever since.
So, when their bet goes awry, instead of taking it like a champ, and saying, "oh, blistering barnacles, we were wrong, here's your coverage, old chap," they try to weasel, lie, cheat, steal and red tape their way out of paying.
It's so disgusting.
The latest ickiness is UMPremierCare: a representative from Dexcom (manufacturer of continuous glucose monitoring systems) told me that PremierCare has the strictest policies on obtaining medical devices. Mind you, they have NEVER paid for a CGM for me. The last one I got was last July when I was still on CareFirst. They make Dexcom send them warranty reports and serial numbers for any previous CGM, whether or not it was covered by UMPremierCare or not. Let me illustrate this for you:
Jane is on CrappyOptOut Plus through her job. She quits the job, and takes another job. Her new insurance is LeastBadOptionCare. When she goes to order a new CGM, LeastBadOptionCare first checks with the CGM manufacturer to see if SOMEONE ELSE has ever paid for a CGM that is still under warranty. They find that CrappyOptOut Plus had paid for a previous system, so they deny her a new one.
This especially sucks when one's CGM has been lost in a field, and one's blood sugars have not been under such tight control ever since.
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