Thursday, May 9, 2013

"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!

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