Tag Archives: insurance

A few D and non-D thoughts.

Because this is my blog, here are a few random diabetes and non-diabetes ramblings, in no particular order:

– Ever notice a difference in how your diabetes works with different insulins? Don’t answer that. I don’t want to know… yet. The fact is, they all work. It makes sense if they don’t all work the same. The trick is in finding what works best for you, and then not using what you’re using as an excuse for results that don’t make you happy.

– Additional note: Don’t tell me they all work the same, then tell me I have to pay three fucking times more for one than I have to pay for another. There’s a point where copyrights of manufacturers and the rights of so-called insurers need to be tempered by the needs of patients who need said insulins to survive. Three fucking times more means the balance is skewed too far toward the manufacturer and/or the insurer, and not enough toward the patient.

– I’m very excited to be speaking later on today with the brother-sister team of Hayley and Ethan Maurice, who earlier this year climbed Mount Whitney, tallest peak in the contiguous United States, raising thousands for JDRF. I’m eager to find out how things have been going since their backpacking adventure, and get a little inside scoop on how things were during their climb too.

– Part of the reason why I’m speaking with the Maurices today, and not before their trip, is because my life has been scheduled beyond belief for the past several months. I mean, I’ve had something scheduled every single Saturday morning going back to mid-May. That’s the last time I’ve slept past 7 a.m. on any morning. Sorry to complain about it so much, but every time I whine about how busy I am, it kind of lets off a little of the pressure I’m feeling, plus it helps me to focus on what is really meaningful, which is the fact that I’m amazingly lucky to be so busy. And this Saturday morning: I’m helping a friend on the other side of town at 7 o’clock. Then I’m meeting a rep from a pump maker. See what I mean?

– I get the fact that people are feeling a little jealous about the ALS ice bucket challenge. I’ve seen enthusiastic ice bucket challenge videos from people who have never donated to any of the diabetes-related things I’ve advocated for. Hell yes, I’m jealous. But I don’t begrudge them one ounce of their fun nor one dollar of their fundraising. I don’t wish Lou Gehrig’s disease on anyone any more than I wish diabetes on anyone. They are both horrific things to have to live with, and the sooner they’re both eradicated from the earth the better. I’m sad that we in the diabetes world get a lot more attention for complaining about an article in the New York Times than we get for helping to save the lives of children who don’t have access to insulin or the means to pay for it. But as I’ve noted before… when I compete, I don’t feel good, even when I win. When I help, I feel good, even if no one notices. So let’s keep our eyes open for opportunities to help, and if we keep helping, I think an opportunity will present itself and grow like this one did for ALS. If: We are all working together. Supporting each other.

– Speaking of other things I (probably) have no business weighing in on: Is it okay now to call this whole Ray Rice thing a fiasco? Maureen probably had the best take on it yesterday when I asked her whether she thought the NFL had knowledge of the elevator video prior to yesterday. She said: “Sure they knew the video existed. They just didn’t want to pay for it like TMZ did. Good for the NFL for not paying for it; shame on the NFL for not doing the right thing in the first place, video or not.” My take: No one should get a free pass on this issue. Including the fans of my favorite football team. The statistics show that no one is untouched by abuse. I’d be really happy if we could say that no one is untouched by protection from abuse. No one. Ever.

Now I’m off to search for those Medicine X videos from last week. I’m jealous of everyone who was there, but in the most supportive of ways. I can’t wait to hear everything I’ve only heard up to now via Twitter and blog posts. Be safe, be well, and remember: I support you… no conditions.
 
 
 

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C’mon, CVS!

From the wonderful relationship that exists between employers and employees in the United States these days comes this little nugget. Go ahead, read it. I’ll wait.

http://www.cnbc.com/id/100573805

Does this bother you a bit? It bothers me a lot.

I’m not bothered by the fact that an employer wants to try to help their workforce get healthier. My employer does many of the same things that CVS is talking about here. In fact, I’ve written about it. Done correctly, these initiatives are a win-win: employees get help identifying and taking action against illnesses they might not have known about before screening. And employers, helping employees get healthier, mitigate some of their risk against future insurance claims. This is especially true if, like a lot of large employers, they are self-insured: meaning, they pay their own claims, but pay the insurance companies to leverage networks of doctors and handle claims processing and other administrative functions.

But that’s about the extent of the good stuff in what CVS is doing here.

If I were to ask questions of the CVS/Caremark CEO, and their benefits manager, the first question I would ask is: Why do you want to penalize employees for non-compliance with a policy, when you could be incentivizing employees to get healthy?

How much that might cost would be in the details of how and what kind of incentives you would deliver, but let’s be honest. The cost would be miniscule. How do I know this? Oh, why don’t you ask the thousands of employers who have been delivering incentives to employees for completing smoking cessation classes, weight loss programs, and medical/bio screenings for decades here in the USA?

Second, I would simply ask if they understood that by forcing their employees to comply (and they are forcing them—when you earn the kind of money the people at the retail store level are earning, you’re forcing them to comply), they are destroying their workforce?

Knowing what we know now about this issue, even if you’re 100 percent healthy… let’s see a show of hands: Who wants to go to work for CVS right now? Anyone? Bueller? That’s what I thought.

Certainly, if you’re a person with good skills and an ability to land a job elsewhere, CVS/Caremark is immediately going to the bottom of your list of prospects. Which means that the new employees they will be landing in the future will be bottom of the barrel talent who can’t get a job anywhere else. And existing employees who might have other choices (like maybe Walgreens or Rite-Aid or, oh… anyone else) are going to bolt the first chance they get too, even if it’s for no increase in pay. Which means the employees that remain after a couple of years under this program are again, bottom of the barrel talent. So, CVS/Caremark: What do you hope to gain here? And have you considered how much it will really cost you? Because it will cost you. You will not save money with this plan.

And you, dear reader, may ask, after 500 words or so, “Hey Stephen… what’s this got to do with Diabetes?”.

I don’t know. I guess I’m saying that I don’t trust a company that will force you to do these things. Because if they’ll do this, what’s next? Will they start denying coverage to people who are diagnosed with diabetes? Thankfully, under the Affordable Care Act, they won’t be able to. But will they try to cut back on what they cover? That, I think, is a very real possibility.

Their new policy says: “Going forward, you’ll be expected not just to know your numbers – but to manage them”. By who’s measure? Will they pay less in claims if a PWDs Hemoglobin A1c isn’t within range (and we all know how difficult that can be)? Will they (for example) try to push someone with diabetes, in their 50s, like me, toward the exit so they can avoid paying what they think will be larger and larger claims until the person is eligible for Medicare? And in doing so, try to justify their decision by pointing at this policy?

Maybe that seems far-fetched. But is it? I mean, they’re already willing to coerce their employees into complying with their demands or risk giving some of their pay back to their employer. Does this sound Anti-American to you? It does to me.

That’s the crux of the thing right there. CVS is portraying this as a wellness initiative, designed to keep employees as healthy as possible. I’m viewing this as being too heavy handed. Mostly, I see what they’re trying to accomplish, at least from their public statements, as possible– if they would just put a different spin on it and act like they actually cared about whether their employees are healthy. And happy. And if they did it without docking employees’ pay or using the information to penalize employees that they are trying to keep healthy in the first place.

By the way, I have a choice of major drugstore chains in my area. And guess what? CVS is not my retailer of choice anymore. They just don’t get it. And geez, these people are running a multi-billion dollar company.

Do you feel the same? Different? Feel free to let me know how you’re thinking.
 
 
 

It’s a numbers game anyway.

I was looking at the Baseball Hall of Fame voting from yesterday, and immediately my analytical mind starting crunching the numbers… baseball is a game loved by statisticians, anyway… Since blank ballots submitted count against players being considered, how would the voting change if those blank ballots were not submitted (then they wouldn’t count against the player)? How many more votes do Jack Morris and Craig Biggio need next year to crack the 75 percent threshold for enshrinement?

Then, since my mind has been on D overload the past several months, I started thinking about numbers and how they relate to diabetes. We all know that numbers are important. Hemoglobin A1c, meter readings, carb/insulin ratios, the whole bit.

But let’s look at some of the other stuff for a moment. I was diagnosed nearly 22 years ago. That’s a fair amount of time, and to the best of my calculation (these are approximations only), here are some overall numbers. I’m going with very conservative counts, so the amount of stuff used and the cost of everything is likely higher than this.

– I didn’t always do a great job of checking my blood glucose. So if I calculate only 2.5 times testing on average, per day, for 8,016 days since diagnosis, that’s 20,040 BG checks. At even 50 cents per strip (which is a very conservative number), that’s $10,020 spent on test strips alone.

– I was on multiple daily injections until almost 3 years ago. For most of that, I was on two injections per day. Then I was on one per day (Lantus) for a couple of years, then Lantus plus a bolus fast-acting insulin before each meal and snack. So again, let’s go with 2.5 per day as an average, for 19 years. That’s 17,350 injections! It’s hard to gauge the amount I spent on syringes, but I’ll try: 17,350 injections divided by 100 syringes in a box equals almost 174 boxes. The average cost per 100-count box is probably in the $24.00 per box range (a quick online check reveals it’s about $30.00 a box now). I’m counting the full price here because my various insurance coverages over the years mostly required me to pay 100 percent for them. So 174 boxes at $24.00 per box equals $4,176 spent on syringes.

– I can’t even begin to guess how much insulin I’ve used over the years, so I won’t even try here. But it’s a lot. And there’s no such thing as generic insulin in the U.S., so the cost is probably a lot. Though most of the cost has been covered through prescription plans. So let’s do it this way: My mail-order pharmacy dispenses 90 day supplies of insulin at an average cost to me over the last 22 years of $50.00 per 90 days. That’s 88 quarters of insulin at $50.00 per quarter, which comes to $4,400 dollars worth of life-giving juice.

– I’ve been on pump therapy for almost three years now. I’ve got a pretty good medical insurance plan at work, so the initial start-up cost for my MiniMed Paradigm® Revel™ pump was right around $500. The durable medical supplies portion of my plan helps me pay for infusion sets and reservoirs every 90 days, and my cost is about $90 per quarter. It’s been about 11 quarters since I started on the pump, so at that rate I’m at $990 for infusion sets and reservoirs and other incidentals (the inserter, IV prep, etc). I’m including the cost for the CGM that goes with my pump, even though I don’t use it all the time.

Total cost of everything above: $20,086

That’s just the big stuff. I could go on and on about doctor visits every 90 days, cost going to and fro seeing doctors and specialists and gathering stuff that I need, and that ill-timed emergency room visit in Dayton, Ohio a couple of years back.

What does all of this make you think about? How much everything costs over time? How about diabetes burnout? Does it make you want to do some number crunching of your own? Is there something I’ve left out? Feel free to add to the conversation by leaving a comment below.
 
 
 

May DSMA Blog Carnival.

I’ve been meaning to write this post for a while now, and judging from the lack of posts on this topic, I’m not alone. You’ve got just about a week to get your entry in for the May Blog Carnival at Diabetes Social Media Advocacy:

Diabetes can sure be expensive. Insurance can help take away some of the financial burden, but sometimes the things we want, or even need, are not covered by insurance. With that in mind, we turn back to our April 18th chat to Fill in the Blanks on the following sentence . . .

I wish my insurance company paid for _________because ______________.

I wish my insurance would pay for more education, more products, and more care for those who cannot afford to pay for their own care.

Let me explain what I mean: First, we know there are many PWDs who either have no access to insurance, or access to high-cost care that is still more than they can afford. We must do what we can for them. It’s not fair that I have access to care that I can still afford (though it’s getting costlier for the same care every year), but others do not. Meanwhile, a quick check of the Carefirst home page (Carefirst is the local Blue Cross carrier in our area) shows that they were involved in providing over $11 million in grants in the last four months for various causes. One of those is an $8.5 million grant over three years to help fund 12 health care centers that provide care to those who don’t have access elsewhere. A check of Aetna’s website (Aetna is my carrier) shows that the company had $1.97 billion in operating earnings last year. Don’t you think that these two companies, plus a few others, can provide a lot for those without care? Just a fraction of that money can make all the difference for someone… or many someones.

How about education about eating right and carb counting? The importance of testing your glucose level? Learning the mathematics of BG and carb counting in relation to insulin bolus? Simple things that you or I know by heart. But those are things that someone without access to care is only guessing about.

Maybe the answer is providing low-cost or no-cost insulin to those who can’t afford it. And among those who can’t afford it, I count those who hoard their insulin, taking less than what is optimal, so they can conserve their precious life-saving resources. And speaking of hoarding… while we’re at it insurance companies, can we stop quibbling over how many test strips are appropriate per day? None of us are using them just for the fun of it.

I don’t have all of the answers… maybe you have some of your own. Feel free to leave them in the comments section. I just know that insurance companies can still make a lot of profit, while helping those less fortunate. That’s the very definition of a win-win proposition. Can we make this happen? What do you think?

This post is my May entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2012/may-dsma-blog-carnival-2/

 

 

 

 

 

 

 

A Disclaimer
I have no medical training. If you consider anything written here as medical, legal, financial, or any other kind of advice, you’re out of your mind. Please speak to a learned professional before making any changes that might affect your health. Any of the original content found on this site is my property and should not be reproduced, copied, or otherwise used without the author’s expressed written consent.

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