Never ever ever ever change your insurance

In a world where dealing with insurance companies feels like navigating a labyrinth of confusion and frustration, my personal saga with my new insurance provider takes center stage. From late notifications to deactivated accounts, debt collection dramas, and the hunt for a diabetes-saving angel, my journey encapsulates the absurdity and gravity of the insurance conundrum.

Act 1: The Late Arrival It all began when I switched to my new insurance on July 1. However, the insurance information was fashionably late to the party, only deciding to function properly around July 5. While they may have missed the fireworks, my stress levels skyrocketed as I frantically tried to inform my medical providers of my new coverage.

Act 2: Deactivated Dreams Amidst the chaos, my durable medical equipment company seemed to take "out with the old, in with the new" quite literally, as they deactivated my account without a second thought. Bills piled up faster than they could deactivate my account, and I found myself in a Kafkaesque battle between claims, phone calls, and inexplicable debt collection notices. (Despite three phone calls to pay my bills—only to be told there was no amount owed—I received a debt collection notice!)

Act 3: The Diabetes Angel In dire need of continuous glucose monitor sensors, I embarked on a quest to secure them. Extending the life of sensors meant less-than-ideal readings, prompting me to make a plea on social media for a diabetes angel. Lo and behold, a kind stranger emerged from the digital ether, sparing me the agony of sensor-less days. Lesson learned: social media can be a guardian angel hub for the 21st century.

Act 4: The Phantom Approval Just when things seemed manageable, a new storm brewed on the horizon. My trusty insulin pump was being discontinued, and the insurance dance began anew. Denials, chart notes, and doctor-document-ping-pong ensued. The pharmacy plan demanded a prior authorization. The doctor insisted the pharmacy needed to start the process. The pharmacy plan said they faxed the request 10 days ago for chart notes. I needed to come in for an appointment so they could send new chart notes. By the time that happened, the prior authorization was denied and a new one needed to be requested. It was a "catch-22" situation that only Joseph Heller would appreciate.

Meanwhile, I have one pod left, meaning that if I don’t get the supplies in the next three days, I will be completely and totally screwed…or will need to send out another plea to Randos on the Internet.

While it's easy to poke fun at the exasperating antics of my insurance company, the toll it takes on my health and well-being is far from humorous. Navigating through their bureaucratic maze has consumed hours of my life, precious days with uncooperative diabetes devices, and added anxiety to an already demanding situation. I guess it was my fault for having the audacity to switch insurance plans.

And as I await my shipment of continuous glucose monitor sensors, I'll be holding my breath, fingers crossed, and a spare sensor from my newfound social media diabetes angel just a text away. After all, who needs functional insurance when you've got a network of online heroes?

Disclaimer: The blog post content is for creative and entertainment purposes only and should not be considered as professional advice regarding health or insurance matters. Always consult a qualified professional for guidance on such matters.

Bad customer service or negligence

 Part one: phone tag

The first calls come in early February. My insurance changed over on Jan. 1, and my DME supplier is calling for a new insurance information. I believe I gave them my new insurance number. For reference, the medical supplier is J&B Medical. The insurance is a Blue Cross Blue Shield PPO in the state of Michigan.

Mid-April: I’m now out of supplies. I really need to figure out what’s going on with this supplier. I start calling the company. I give them my insurance number several times over. Nothing seems to move. 

Relevant and frustrating piece of information is that I went to a doctor’s appointment at my endocrinologist on March 22. I was literally in the office on time when the receptionist told me the doctor had cancelled my appointment. The doctor was very strong willed about this, citing that she could cancel it because I was late, because the appointment details ask that you arrive 20 minutes early. I’m still unsure of the actual policy. I filed a customer service complaint and I’m pretty sure I’m now getting iced out. 

May 2: I am totally out of supplies and have no way to get any. I start calling the medical device company regularly. I have the same conversation over and over with different people which includes some version of this:

Did your insurance change?

Yes, I have already given this information several times.

It seems like your insurance hasn’t been verified yet.

Okay so go ahead and verify it. 

Great I will take care of this, I will call you back within an hour. 

One hour later… crickets. 

May 10: after 69 minutes on the phone and talking extensively with a supervisor named Rico, I am assured that it will be dealt with. Rico tells me that he has filed a formal complaint within his company and the policy requires that I get a phone call back in 24 hours. 

24 hours later… crickets. (Verifies by my phone records.)

May 13: calls totalling 15 minutes and 33 minutes… I finally get some information: the insurance was verified. According to J&B the insurance requires chart notes from my doctor in order to authorize CGM sensors. The chart notes need to be from within the last six months. Unfortunately the only appointment I had within the last six months was inappropriately cancelled by my doctor. I am also almost out of paid time off days, partially due to the day I took off in order to go to that appointment got cancelled. Also, as a teacher it’s very challenging to take a day off at this time in the year. It’s super busy and a lot of people are out due to Covid and flu. 

They also tell me that I received a phone call from a supervisor name Victoria the previous day. Phone records indicate no such call. The current supervisor I’m on the phone with is being very confrontational. Yikes. 

So here I am, several months later, with no supplies and I owe another diabetic two sensors that I’ve borrowed so far. I have no clue if I’ll be able to make an appointment any time soon with my endocrinologist. 

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.
Sincerely, 
Diabetics


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.

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.

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.

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

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.