Tag Archives: healthcare

It’s Thursday of #dBlogWeek. This is the post about The Healthcare Experience.

Welcome to Diabetes Blog Week! Diabetes Blog Week is just like it sounds… diabetes bloggers all blogging on daily topics for an entire week. Or, in this year’s case, for five days. To find out all about Diabetes Blog Week and to sign up,

As always, thank you to Karen Graffeo, creator and curator of Diabetes Blog Week. She’s awesome.

It’s Thursday… today, we’re covering The Healthcare Experience.
Most people who live with a chronic illness end up with a lot of experience when it comes to dealing with healthcare. How would you improve or change your healthcare experience? What would you like to see happening during medical visits with your healthcare team? How about when dealing with your health insurance companies? What’s your Healthcare Wish List or Biggest Frustration? Today is the day to share it all!
Today, I’m going with a suggestion from a Facebook friend whom I’ve never met, who would like me to talk about CGM coverage for Medicare recipients in the United States. They’re concerned that a recent story out at Insulin Nation, plus a couple others here and there, might be giving people the idea that Medicare coverage for continuous glucose monitors is a done deal, or a nearly done deal.

As much as I would like that to be true, the facts are that this is not true.

And that makes this issue similar to many issues when it comes to living with diabetes and getting the coverage for things that will help us live a better, healthier life.

You name it, insurers are doing their best to keep from covering it: the insulin of our choice, coverage to see a psychiatrist for our mental well being, coverage to see an orthopedist to look at frozen shoulder problems, and yes, Medicare CGM coverage.

Even when one patient wins a case, do you think that ends it? No… insurers are still going to try to appeal and get a legal authority somewhere who will agree with their point of view. Even when their point of view is not backed in science, or even recent science.

If I were to improve healthcare in this country, I would start by disassociating the budgetary (and for companies, profitability) concerns of every facet of managed care. The first question should always be, “what will help the patient the most?”. Only after that question has been answered should we begin to ask how expensive something truly is. And once we have determined how expensive the best treatment will be, we should commit ourselves to making it affordable for patients. Not if we can make it affordable; we should commit our resources and our best minds toward making it affordable. And accessible. For everyone.

When we dedicate ourselves to the idea that everyone deserves the best care, period, not the best care one can afford, we free ourselves from the burden of “how are we going to pay for it?” or “how can we get someone else to pay for it?”. It will happen. It will happen through grants for healthcare innovation, additional competition from insurers (not less, as some politicians are suggesting, unless they want to go single-payer-all-in), and through price controls. I still believe that the part of our government designed to protect the people should be bigger than the part that wants to help companies prosper. Companies never cured a soul.

Companies pursue mercenary agendas based on profitability. They will keep defending their right to do so. All I’m doing is defending my own right to manage my care with the tools I need to be successful. At a fair price, which, in case anyone is wondering, is a lot less than what I’m paying now.

So friends, don’t be fooled by the “Medicare might be covering CGM!” rhetoric you might read from time to time. Our issues are not going away until we collectively knock out every brick in the wall of managed, for-profit care that so many of us have run into during our lives with diabetes. Patients over profit, every time.

PPACA Survives intact.

Healthcare advocates throughout my country were thrilled yesterday when the U.S. Supreme Court upheld the part of the Patient Protection and Affordable Care Act (“Obamacare”) that allowed for subsidies to help patients pay for healthcare insurance obtained through insurance exchanges nationwide.

Had the justices overturned that part of the legislation, something akin to chaos in the insurance marketplace could have ensued, owing to the fact that many who can barely afford coverage with the subsidy probably would have dropped their coverage and risked prosecution for not being covered at all. It might have meant that many who are relatively healthy but still couldn’t afford the coverage without a subsidy would drop their coverage, which would have put insurers in a tough spot, with too many chronic and acute issues to pay for, and not enough money coming in from healthy patients to make up the difference.

The vote of the nine-justice panel was 6 to 3. Chief Justice John Roberts wrote the majority opinion, once again surprising many who thought he was the perfect neo-conservative to lead the highest court in the land when President Bush appointed him to the post a decade ago. His remarks included this little nugget:

”Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”
Imagine that… he goes against nearly every republican in America, using one of their biggest rallying cries to do it: Free Market Capitalism!

The dissenting opinion, given from the bench by Justice Antonin Scalia, smacked of sour grapes, though I guess every dissenting opinion does to some degree. At one point, he got laughter from the courtroom for saying “We really should start calling this law SCOTUS-care”. He also referred to the majority opinion as “interpretive jiggery-pokery”.

Well, I’m just a high school graduate, so I never learned from books that contained such eloquent terms as “jiggery-pokery”, but I really hope that Justice Scalia, or Justice Alito, or Justice Thomas, who also sided with the minority, never have to experience moments where they have to choose between paying for healthcare for themselves or a loved one, and paying the rent. Republican members of the U.S. Congress, for their part, are still vowing to repeal this important legislation. They’ve already tried repealing all or parts of it 67 times.

I will also point out that a day later, our fair republic still stands, and still stands for the right to healthcare for everyone.

If we’re not for that, what are we saying? Really… if you’re against my right to affordable healthcare, are you saying that, although my diagnosis of Type 1 Diabetes is not my fault, I don’t deserve to be able to afford to pay for care, drugs, and devices? Are you saying I should “work harder”, “get another job”, “do whatever it takes”, or adhere to some other catchphrase out of the conservative handbook?

Well, let me quote from another one of your favorite books, the holy bible.
Matthew, chapter 25, verses 44 through 46:

“Then they themselves also will answer, ‘Lord, when did we see You hungry, or thirsty, or a stranger, or naked, or sick, or in prison, and did not take care of You?’ “Then He will answer them, ‘Truly I say to you, to the extent that you did not do it to one of the least of these, you did not do it to Me.’
These will go away into eternal punishment, but the righteous into eternal life.”

Again, I am thrilled at the result of yesterday’s ruling. I do recognize that the law isn’t perfect, but had the challenge to the law been upheld, it would have been even less so.

Now, as I mentioned on Facebook yesterday, we can… continue to defend this law against all manner of attacks. Hopefully, yesterday’s decision makes defending it easier.

In other news: The Supreme Court just handed down another ruling, legalizing gay marriage nationwide. It’s been a busy week, Justices. Take the rest of the summer off.

It’s all intertwined.

I’ve been feeling a little off the past few days. Physically off. It’s not an “I feel like crap” feeling. More like, “I’m definitely not one hundred percent”.

But when I get this way, I can’t help but think about the autoimmune origins of my Type 1 diabetes. Having an autoimmune disease makes you more susceptible to other ailments.

I had a tooth problem a couple of weeks ago. There was an infection, and I needed to take an antibiotic prior to getting a root canal last week. And now that the infection is at bay, and I don’t have the root of the tooth left (which means I shouldn’t experience any more pain there), I feel kinda lousy this week.

Which makes me ask certain questions:

Since I already live with Type 1 diabetes, is my immune system compromised to the degree that I’m more likely to experience these kinds of issues back to back?

Do I have to worry that each time I take an antibiotic I’ll be less likely to be helped by it? Will that be compromised by my faulty immune system?

Will all of this get worse as I get older?

If that’s true, how do I mitigate the effects of, well, getting older?

It’s that last question that really gets me going. I don’t like being sick… I’m not a good patient (except for the diabetes, and it’s taken me nearly 24 years to get there). If I’m going to feel better in the future, I’ll need to become more knowledgeable about everything having to do with my health.

For now, my diabetes numbers are looking pretty good through all of this. I have to do what I need to do to feel better, and then learn more about my diabetes, my overall health, and how they go together. We never stop learning. I hope.

Things I wish I had.

I see another multi-millionaire has sprung up this week, thanks to a winning Powerball ticket sold in Knoxville, Tennessee (I didn’t even have to look up how to spell Tennessee—got it right the first time!).

Scoring the winning ticket for the Powerball or Mega Millions jackpot would be sensational—a life changer for myself and my family. It’s definitely one of the things I wish I had. What are some of the other things I wish I had? Hmmmm……
– I wish I had a working pancreas. That goes without saying, right? Top of the list, every time.

– I wish I had the ability to know where my BG was trending without drawing blood. Not in that “I’ve been to the bathroom three times in the last half hour, I must be high” kind of way. Just through osmosis, if that’s the right definition of the word.

– I wish I had the knowledge and the time and the money to devote my life’s work toward making life easier for People With Diabetes. I’d start with dual objectives: 1) Development of a bona fide, foolproof artificial pancreas system that’s so inexpensive, all insurance plans would cover 100 percent of the cost; and 2) An education system for people not living with diabetes, so terms like “Diabetes Police” and “You can just get rid of it with diet and exercise, right?” would be a thing of the past.

– Third objective: Heal the rift between some members of the Diabetes Community who hate on those not living with their type. Theme: They’re All The Bad Kind… So Be Kind. (sorry, it’s the first thing that popped into my head)

– Fourth objective: Provide everyone living with or affected by diabetes with exactly as much support as they need, when they need it. This would include professional help where necessary, and access to resources wherever a person is, even if they’re not at home. This includes people in countries with limited or no access to insulin. Why can’t we?

– I wish I could go to every kid fighting their way through their teenage years while living with diabetes, put my hand on their shoulder, and let them know that they are more than worth every single difficult thing they’re going through. It’s okay to love yourself, kids. Just the way you are right now. Never give up. Never give up. Never give up.

– I wish I could develop a plan, like a Ready.gov plan, that would allow PWDs to gather all of their important information in one place, then share that data immediately at critical times and places like hospital emergency rooms, diabetes camp, and schools. I’ve been thinking about this kind of thing for a while. Why can’t we?

– I wish I could fix our healthcare system in America. I could do it too, if I also had the ability to get lawmakers, healthcare systems, drug companies, device makers, and a host of others to realize that patients are people, and corporations aren’t.

– I wish I had the ability to eliminate all middle-of-the-night hypoglycemic episodes, for everyone, forever.

– I wish I had the ability to make insulin unnecessary while swimming. Or showering. Or anything water-related. Never again would someone have to ask “Are those waterproof?”.

– And world peace. Because: Why can’t we?
Now… what are some of the things you wish for?

Prescription burnout.

I’m fortunate. I have access to and participate in medical, dental, and vision insurance through my employer (The Great Spousal Unit is also covered under my plans). It’s not cheap to have this coverage but, for the most part, I’m able to manage the costs. Despite needing to schedule appointments and, you know, actually go to doctor appointments, I’m able to do what I have to do to navigate my way through the healthcare system here in America.

Except when it comes to prescriptions.

Dealing with prescriptions is hard. The reasons for that vary, but they’re mostly related to the number of items I have to keep track of, the fact that they all seem to need to be renewed at different times, and the stupid way my prescription provider operates.

For the record, I get insulin, plus backup insulin, glucagon, a few daily pills I need to take, and test strips through my prescription provider.

Almost all of these, except the glucagon kit and the backup insulin, which I don’t need to renew all the time, are on different rotating 90-day schedules. Meaning, I have to go to my provider’s website and renew my prescription, or my doctor can electronically submit prescriptions to the provider. Though that turned out to be a major hassle with the provider, which I’ll explain farther down the page.

I generally don’t suffer from diabetes burnout, but I do suffer occasionally from prescription burnout. It’s not that I have to renew my prescriptions every 90 days. It’s that I may need to renew one prescription this week, and another in three weeks, and another ten days after that, and another the following week. Keeping track of which script needs to be renewed when takes some doing.

I try to keep track of it on my Outlook calendar at work. That works okay, except when I’m not at work, and as long as the Exchange server doesn’t go down and wipe out everything I carefully scheduled (which happens occasionally).

Then there’s the cost. My provider introduced a huge change in their formulary list this year, which is costing me an additional 1200 dollars during 2014. I don’t even want to go into that.

So there’s the volume of everything that needs to be renewed, and the quirky scheduling of everything, and then there’s this:

When renewing my prescription online, the provider has my credit card information so they can process my order at the time it’s placed. So they have my credit card information on file.

The last time I visited my endocrinologist, she was kind enough to get me new prescriptions for things I had run out of refills for. The best part was (or so I thought), she was able to send the script directly to the provider so they could fill it. Great, right? Ummm, no.

A couple of weeks (or so) goes by, and no prescriptions. Part of the order included my insulin, so I’m starting to worry a bit. I give the provider a call. It turns out they haven’t filled my prescription because they “didn’t get payment yet”.

Me: You have my credit card information on file… what’s the problem?

Prescription provider phone rep: We can’t fill the order without your authorization of payment.

Me: You do it when I renew prescriptions all the time… how is this different?

Prescription provider phone rep: We can’t fill the order without your authorization of payment.

Me: This is a highly inefficient way of doing business. My doctor sends the prescription directly to you, then I have to wait to find out it’s not coming, then I have to call you, then you tell me I have to provide payment when you already have my credit card info on file.

Prescription provider phone rep: We can’t fill the order without your authorization of payment.

Okay, I realize there’s a difference between “providing payment” and “authorization of payment”, but still… why do I have to find this out on my own? Why was I led to believe my prescriptions would be shipped when they weren’t? Why was I not told that they were waiting for my okay before filling my order?

I don’t want to say the provider did this on purpose. I don’t think their purpose was to deny or delay my prescriptions. After all, if they don’t fill a prescription for me, they don’t make money. And that’s where the problem lies.

It’s just my opinion, but it seems to me that prescription providers, more than any other entities providing goods, services, or prescriptions through an insurance plan, are not about the patient at all. Not in any way, shape, or fashion. No… they are purely profit centers, and they operate as such. I don’t think my provider wanted to deny my coverage. I just think they skimped on customer service and expediting orders in an effort to make a few extra bucks. They hired someone to think this all out, but they didn’t pay top dollar, so what they got was a system that doesn’t really work at all.

And they don’t seem to care about it, because, let’s face it… once I’m on their plan, they have me for the entire year. At that point, they don’t have to be nice, or helpful. They just have to squeeze as much money from me as they can. If they have a stupid, inefficient way of doing that, who cares? They know I’ll be back when my next prescription needs to be filled.

I suppose it hasn’t occurred to providers yet that better customer service could help expedite orders, rather than having them sitting in a queue somewhere. More orders, more money, more profit. And I suppose it hasn’t occurred to them yet that a superior level of customer service could have a positive effect on patients, and the plans they’re covered under, which might make their plans more appealing to additional clients in the first place. More orders, more money, more profit. That requires too much forethought, I guess. I wonder if they even know what that word means.

Oh yeah, it’s prescription burnout I’m feeling. Or prescription provider anger. Either way, it’s not healthy. And my provider is perfectly okay with that. As long as I keep coming back for more.

%d bloggers like this: