Blog Entries With Tag: insurance

Blog: Anna's Blog

From: FatCatAnna

... my new Animas One Touch PING (I think of the game ping pong with that name) insulin pump that I started on yesterday aka Ziggy and his side kick Stardust - the OneTouch meter remote (no more lifting my skirts up to reveal my knickers to the world when I want to do a bolus).  

It will take abit of getting used to how much blood Stardust uses compared to Limoncello - my FreeStyle Lite (who will remain as my standby for days I can't squeeze out large droplets of vampire blood.

I had wanted to change to the Vibe, which has the CGMS option on it's screen which is an extra $200 (the PING is $6,995).  I paid for it on my credit card that is allowing an extra 1 year warranty on it on top of the 4 year warranty you get with the pump (having had previous probs with the 2020 - I wanted to ensure I had 1 extra year more).  I'm one smart cookie aren't I?  Well, you won't think so after reading the following.

Laws here in Canada do NOT allow you to change your mind once you've purchased a pump ... even if the box isn't opened - live and learn - or move to US of A - where you have better consumer protection - from some of the thread discussion I've read on forums.   

So, tonight - it's installing a Dexcom G4 sensor - the transmitter and receiver was given to me by islet cell transplant - who now insulin free (whoo! whoo!)  from Alberta.   I may continue to use it out of pocket once the Christmas present of box of sensors that my Animas rep gave to me (ususallly a box of 4 will set you back $340 for a month supply - cha ching) - runs out.

One thing I am finding out about the Dexcom ... after reading/watching the videos on their site.  They keep on telling you that ... the CGMS does not replace your blood meter ... that whatever your CGMS tell you - that you should go with what your finger prick #BGNow number is.  This is one thing I did not realise when looking into the CGMS.  I knew a blood test had to be done a few times a day - but not some of what I came across at this link.  Therefore, you still have to purchase perhaps as many blood test strips as you had before, in order to stay in a good BG zone.

So, between testing still with the finger sticks as some of us call them - and then to justify the the $7K yearly cost is abit scary (like buying a used car every year as my DH put it to me - men are so practical when it comes to justifying a purchase).   Thank goodness for DTC here in Canada as well, but we have yet to see how much we can claim since I was approved a few years ago ... it's sitting down ... pulling out past income taxes, etc. etc.  aka - we'd rather be sailing - than crunching numbers.  Though my DH says he'll keep on working as long as he has to for affording these items - but the rotten thing is ... he's able to retire next year after 35 years. 

GUILT!!!

Can you tell that I feel so guilty that my DH has to work longer due to my diabetes at times?  That shows you how much someone loves you when they give up their retirement plans for you (his are sailing around the world - but you never know - maybe we'll be able to do it).

So, here's to the next adventure with devices from Animas .... 

Blog: Anna's Blog

From: FatCatAnna

The other day, an American Type 1 diabetic on Facebook wrote to me asking if I could help them in finding more information for a low potassium diet and recipes to go with the foods they’re allowed to eat.  They’d seen their kidney specialist and told to go this route.  What really got to me was when I asked if they were going to see a dietician or at least a nutritionist was that they'd received a paper – with what they could eat / not eat.  That was it!  

Not that I’m an expert, but I sent them some links from the National Kidney Foundation that at least explains more than what their doctor had given them.

I managed to link them up within a few hours with another Canadian diabetic mate of mine, who has been on a low potassium diet for a decade, and hopefully that will help.  It really amazes me how these days, we often have to go this route, not via our medical system.  What really surprised me more with my American friend was that his health care insurance doesn’t cover for a dietician / nutritionist (they are covered though for an insulin pump/CGMS pump).  It's like, WTF, won't more cost be involved from the insurance company if the person has kidney failure?  Urrhhhh. 

I’m sorry, but as Canadian, who may pay higher taxes, may have bit of wait time to see doctors/surgery at times compared to the USA.   I know that the province I live in (Quebec), I can make an appointment, upon the recommendation of my doctor, to see a dietician.  I had to at one point, when I needed some help with losing weight (still am trying to shed – that’s a never ending story).  The main thing, I can go to local government run clinic or hospital, and get the help I need.  If I have work insurance coverage, often to see someone FAST, the most you'll pay out of pocket is 20% for that faster service.   Either way, n-between the wait time, I do my own research, and of course, don’t leap to any conclusions due to … not everything you see online is the gospel truth!

Of course, no health care system, whether public like Canada's is or in the USA is perfect.  Actually, no health care system world wide is perfect … people gripe about paying more taxes to fund them, but you always hope that that extra you are giving to the government isn’t being used for admin and other nonmedical needs.  

Take for instance, my recent PAP smear test - to be analysed in Quebec system, takes 6 months.  Other provinces are 1-2 weeks.  The reason for wait time in my province?  Smaller population, less tax dollars going into the medical system.  Of course, healthy individuals that don't use the health system, would get upset to fund the kitty with extra tax dollars, but that's the way our system works, and usually for the better.

Anyway, before I rant more about health care - and make this an epic blog that it wasn't supposed to be - on closing words - check out this latest report from the nonpartisan health organization, the Commonwealth Fund  … this will get you debating together at the dinner table, if it doesn't get you commenting here on my post!

Blog: Anna's Blog

From: FatCatAnna

UPDATE -** NOVEMBER 18TH 2013 ** - I HAVE FINALLY BEEN APPROVED TO USE THE I-PORT! Why it took my insurance company so long is beyond my comprehension - but now I'm so excited - especially when I take my next holiday  - where I can't risk having my out of warranty insulin pump go wonky on me - this will make my MDI (multiple dose injection) regime so much easier!!!!

*******************

I posted this blog the other day at Blogger - and thought I'd share it here with you at Diabetes1.org! 


Okay, okay, don't get your nose out of joint - my fellow insulin pumping peeps - that I'm saying that the i-port is a mini-me insulin pump - but in away - when you look at it "logically" without any anger from my statement - I AM the "mini-me" pump - I am the brains behind what goes into my body - via the i-port - I AM IN CONTROL - not a machine - that I've programmed with best intentions to keep my diabetes health in control.

 

Yes, I still have to give a separate shot for my "basal" rate with long acting insulin  - I do this twice a day - 12 hours part seems to work best for me.   The basal rate is basically what your pancreas - if it's working - squirts out all the time - in order to keep your blood sugar in a normal range when your not eating, etc.   With diabetes - your pancreas can be abit on the wonky side and either work when it feels like (e.g. Type 2) or like myself as a Type 1 - where my pancreas is dead as a door nail. 

The recommendations of the i-port website is that only ONE type of insulin being put thru' the port via either a pen needle (no shorter than 5mm) or syringe (28 gauge is the thickest - otherwise you could ).  I'm fine with that that I can only use the port for one insulin.  With a "real" insulin pump which has an insulin cartridge that stores insulin (the i-port doesn't - you INJECT the insulin thru' the port) - we all know it's programmed to squirt out ""X amount" of  rapid acting insulin - for your basal rate as well as your bolus rate (aka - if you have to correct a higher than normal blood sugar (BG) or for when you are eating a meal).  If this has got you abit confused about the types of insulin - check out the link from Diabetes.co.uk that explains how injected insulins work in our bodies.  

My messy diary along with box from i-port

The thing I loved about my six day experiment with the i-port (I was only given 2 samples - boo! hoo!) - is that instead of my having to do the human dart board practise on my stomach for my bolus shots 5-8 times a day - I just did my insulin injections through the port in my skin.  It really is like an infusion set that we use with an insulin pump - except it has no tubing - or connections to a little machine that goes ping.   The port is changed EVERY 3 days - which is the recommendation for most infusion sets.  Usually in the past, I've had issues with the teflon coated plastic cannula that remains in my body for that length of time.  Luckily, with the i-port I had no such issues, removing the port left barely a mark in my skin. 

The good thing about the i-port - less expensive then the alternative of an insulin pump (I can purchase the i-ports at Diabetes Express for $149.99 CAD for a box of 10).  This is bit less expensive then what I was paying for my infusion sets with my insulin pump - but the even bigger saving for me?  I'm not having to pay for a pump which ranges from $5-7K depending on where you live - along with the other supplies that go along with the pump (insulin cartridges, batteries, replacement caps, etc.). 

i-port put in place (really easy)

One thing I did find was that I didn't cringe at having to give another shot of rapid insulin for a little sinful snack or a correction shot.  It reminded me so much of the insulin pump I used to use - where a simple touch of the key pad - squirted insulin into my body via the infusion set - except with the i-port - you are the brains behind what insulin you are injecting with.

I have submitted a predetermination form thru' my husbands workplace insurance in the hopes that these ports will be covered - hopefully at 100%.  So wish me luck - since I'm really REALLY missing my little i-port right now - I felt very spoiled using the two I was sent. It's almost how I felt when I first disconnected from my pump - and went back onto multiple daily injection (MDI).  After almost a month of learning how to stay in the BG zone with MDI - I can now say - that ANYONE can do it - if they put their mind to it - and now I'm not missing my pump as I go into my 4th month of being pump free.

It stands out about 1/2" or abit less

My conclusion?  For anyone without insurance coverage - dislikes injecting to the point of not wanting to inject (not good - tisk - tisk - who hasn't done that in their life time with diabetes?) - I really think this is the route to go - to keep a diabetic from suffering the effects of poorly controlled diabetes.  

NB:  The i-port Advance has regulatory clearance in Canada, US and the European Union.  In the EU they currently have distributors in Germany, Italy and the Nordic Region and are in conversations to add some additional countries in the near future. India and Australia will be further down the road. 

Blog: Doris' Blog

From: dorisjdickson

Remember this medical billing code - V700.  Why?  In Massachusetts, V700 is the code to ensure that tests you have performed during a routine annual physical are covered under the Massachusetts mandate. 

Codes are standard through the country I realize; so, it is the same code used in other states to designate an adult routine annual physical.  However, at least until national health reform is passed, it s the one that designates a number of tests that are covered without being subject to a deductible, coinsurance or multiple copayments.

According to the representative at BC/BS I drilled earlier in the week, even my A1C and TSH are covered, even though they are not standard routine tests; they are diagnostic.  It is important to share this information with you because frequently tests are separated at the doctor's office and performed by multiple outside vendors. 

Trust me; providers do not always enter the appropriate code and if they do not (depending on your plan details and potential deductibles) it may appear you are responsible for test costs that should be paid under "routine annual physical."  This has happened to me multiple times because my primary care physician sends blood tests to the hospital lab (at another location) and the lab does not bill the insurance company properly.  Thus, I have received a separate bill for the lab tests. 

Wrong!  I get a bit testy and send it back with a note stating, "bill properly and you will be paid"!  I do not necessarily remind them what they did wrong.  I should not have to even know what the problem is and the mistake does get a bit old.  After all, this was a selling point of HMO and PPO coverage - not patient intervention, double billing, paperwork, etc.

Also, if they continue to bill improperly, they can not charge you.  They have a specific amount of time, based on the contract they signed with the insurance company, to properly bill the insurer.  After that, they have to "eat" the unreimbursed costs and they are not allowed to charge the patient for their mistakes.  Their mistakes are not your problem. 

It is that simple but you need to know it is that simple.  As long as you have provided the caregiver with your accurate provider information, you verified they are an approved provider (if necessary), you have active coverage, etc. you have performed the required "patient responsibilities."  Beyond that, it is up the provider.

So, the next time you have a routine annual physical and a bunch of separate tests (in some states including a mammography, pap smear, EKG, etc.) remember to pay attention to the code they use especially if you end up with a bunch of separate bills.  The code is V700!