Yesterday evening, I was in a pretty awful place with this whole how-diabetes-affects-my-family thing, which you likely surmised if you caught last night’s post. I’ll be the first to wax poetic about how diabetes is a “family disease”, but sharing the responsibility of it doesn’t necessarily make it less burdensome for all involved all the time. Sometimes it’s a relief to have someone with whom to share it. Sometimes it just seems to illuminate what a miserable disease it is to try and manage day in and day out for eternity.

For anyone who thought perhaps I’d gone cross-eyed, adding an extra zero to the amount of money that it will cost us to add me to Jason’s plan, that was the correct number. $1000 will be deducted from his paycheck every month. The hilarious thing is that he works for a home health care agency, one that sells the merits of taking care of people, but obviously doesn’t give a flying… uh, fig about the health of its employees and their families. Jason has fumed about it for years. Three or four years ago, we actually added Jason to my health plan because he planned to have elective surgery. The out-of-pocket costs for the surgery under his plan were much higher than the additional monthly cost of adding him to my plan for an entire year, so for that year during which he had the procedure done, he was under my plan since the plan through his employer barely covers anything.

Not This Year

I have to hand his employer props though for having their annual meeting in Orlando this coming March. We planned to make a vacation of it, but after a lengthy discussion Monday night, decided that we can’t afford it. While they’re covering all the costs of their employees, they obviously aren’t paying for family members. Jason has been to Disneyland, but I’ve never been to the Magic Kingdom, so he doesn’t want to go without me. As disappointed as I would be if he went without me, I told him that if he wanted to go, he shouldn’t skip it on my account, but he insisted that if I couldn’t go, he wasn’t going to go because it should be a family vacation… well, the human members of our family anyway. Since we have to get my health care through his employer, we can’t afford to make a vacation of it though. Funny how they have an insane amount of money to schlep their employees from all over the country to Florida, but apparently no money to invest in better health plans or defray the share that employees have to pay to add their families. The irony isn’t lost on me, and yes, as a matter of fact, I’m bitter.

I always like comments, but yesterday I especially appreciated the responses to my post about all this insurance mess and the guilt I feel – the support, encouragement, empathy, suggestions, and offers to help. I know that most of us struggle with the diabetes guilt to varying extents, and it manifests itself in different ways for us all, but it was comforting to read about how you’ve coped with it, how it affects you, and how you ‘get it’. As I suggested, there never seems to be a conclusion to the guilt, only tumult interspersed with lulls. However, on a positive note, at least there appears to be a conclusion to the prescription issue. Since that wasn’t really the point of my post yesterday, just the precipitant to this current instance of emotional fallout courtesy of diabetes, I didn’t share the resolution so I thought I’d offer that today.

When we got home Saturday evening, I found the information I had received from my new prescription provider, WellNet, about a month ago that described my benefits. I had glanced at it when I first got it, but not all that closely. Since I’m on COBRA and no longer with that employer, I had no idea this coverage change was occurring, so when I received the information in the mail, I was more focused on calling the benefits specialist at the former employer to find out whether or not my durable medical equipment benefits would still be through Horizon or if they’d be through WellNet. Since I’ve been trying to sort out my sensor coverage, I temporarily freaked that DME would now be through WellNet, and I’d be forced to start from scratch yet again to get sensors. In that commotion, I failed to more closely examine the actual prescription benefits. After the confusion about getting more than a 30-days supply at Walgreens on Saturday, I figured I should have a look at the fine print.

At the top of the form that outlined the benefits, I read, “RETAIL (up to 90-day supply; one co-pay applies for each 30-day supply)”. I should have been able to get the 90-day supply – or the 60-day supply in the case of the insulin. That meant I needed to call and straighten this out, which aggravated me since I despise how much time I spend calling insurance companies, doctor’s offices and medical supply companies trying to straighten out other people’s inability to correctly provide and bill the benefits for which I pay. I checked the customer service information, hoping they had 24/7 service so I wouldn’t have to wait until the work week, but alas, that’s what I had to do. On further examination of the program details, I also noticed the “Diabetic Option: All diabetic supplies are covered at a $0 copayment if filled at the same time as injectable insulin.” Something good! As long as I’m getting my insulin refilled, all the other diabetic supplies, which normally is just test strips, but occasionally includes Keto-Stix or glucagon kits, will be free. Free is good, and I’ll very graciously take it.

I also looked at the formularly list, and was happy to see that Humalog is on their formularly list. I had switched from Humalog to Novalog about 6 months ago because under the Horizon prescription benefits, Humalog wasn’t on the formularly. I’m partial to it, for no other reason than I’ve almost always used Eli-Lilly insulins, and I like the maroon bottle top. I know, that’s flimsy reasoning, which is why I switched to Novalog, but next time I see the endocrinologist, I’ll be getting a script for Humalog.

Having a better idea of what exactly my benefits were, yesterday I called WellNet. I get in defensive mode every time I call to straighten out something like this because I expect to have to explain to someone why I should be getting a benefit they’re not giving me, or why I shouldn’t have to pay for something for which I was charged, or why I need to speak to a supervisor. More often than not, defensive mode serves me well, but as it turned out, the lady was very helpful. She confirmed that I should be able to get up to and including a 90-day supply if that’s what I wanted. Once that was verified, I explained the whole issue with the quantity of insulin bottles, and how I want to go back to the pharmacy and get another 30-days supply to augment the 30-day supply I picked up Saturday, but I wanted it to be the 2 bottles to make up the difference of what I would have received had I just been able to get the 60-day supply I initially wanted. She said she would call the pharmacy and straighten everything out, and then took my number and said she’d call me back after she resolved everthing with Walgreens. I never heard from her though, so I won’t know for certain that I’ll be able to get the quantities I want until I go back to Walgreens. I don’t know if I should take it as a favoarbel sign or not that she didn’t call as she said she would, but hopefully now that I’m up and running on this plan, I won’t have any more issues getting my prescriptions. Who knows what lays ahead once I’m on Jason’s plan (or whatever health insurance for which I ultimately qualify), but I hope that this ends up being the only headache I experience as long as I’m on the WellNet plan.