The never-ending, never-knowing state of “denied” drug coverage. Part 2

First part here.

I called the Baqsimi savings card program to find out how to activate the card. They said you don’t need to activate this card. They also said my local pharmacy needs to call them so they can transfer some information and then I will be able to get my free first product. Okay….

Off I went again to my local pharmacy. I relayed this information and gave them the sacred telephone number they needed to call to make this magic work. They called. Long story short: I am not entitled to this savings (Baqsimi for free, link in first part) because I have Medicare. First big let down, confusion, inaccuracy, bias against old people, you pick.

I asked my pharmacy what would a two pack of Baqsimi would cost under my Medicare coverage. Answer: $270. The reason this is interesting is because when I was on the phone with Medicare questioning the “sort of, but not, denial letter,” (I refer you to the first part of this story as linked in the first line), I also asked them what will it cost me as they’ve approved coverage. They said it would cost me $221 for one bottle and $442 for the two pack. Yes, almost twice as much as what my pharmacy quoted me and I paid. I guess I’ll know tomorrow if that’s accurate when I pick it up.

Moral of the story: There is none. Our healthcare system is broken. When I related all this to the husband, he laughed like a hyena and said, “They want you to suffer!” (pharma, the health insurance companies). At least he got some good happy hormones flowing.

So with no moral I’ll just offer this advice. Do everything in 3s: Research online, research by asking your friends, research by scanning sites. Ask a company rep, then ask another company rep, then ask your pharmacy. If your claim is denied, appeal, appeal, appeal.

I’ve read it too many times – health insurance companies deny everything today expecting people not to bother to appeal, but those who do very often get what they fight for. It’s not a happy story, this is not the world I want to live in, but it’s the only way I know to work within the system.

Note: I sent these two posts to my wonderful endo and he replied, “Thanks for sending… sorry to find this outcome. The challenge with CMS and Medicare is that they are typically about 3-5 years behind the current with regards to coverage etc. If I were to write an “off shoot” article from yours, it would be about how I call the “physician appeal line“ and get re-routed 5 times between people telling me it’s not in their department’s job to handle what it is I’m asking for. Finally, I end up with the same person I started with and try to channel all of the calmness I have stored, while listening to on hold music. Or, what’s worse, is having written an appeal letter that has literature citations and a detailed list of reasons why a patient needs X drug or Y device, it being made abundantly clear during the peer to peer ( MD to MD ) phone review and find no one has read my letter. The world we live in … and yet, nevertheless, she persisted.”

Conclusion: Healthcare is also broken for health professionals. Finding a good one is half the battle, especially when they battle for and with you, realizing they too find a powerful force aimed at deferring them.

The never-ending, never-knowing state of “denied” drug coverage. Part 1

If the husband had been filming me this morning while I was on the phone with Medicare, and we posted it, it would have gone viral. I’m sure. A bit like Norway’s very popular “slow TV.” Throughout I was the picture of calm. Amount of minutes spent on phone: 57,  number of reps talked to: 4, number of departments switched to: 2, number of times I had to call back because they dropped the call: 2.

My call was prompted by this letter I received (black boxes just to cover my personal details) that said I don’t have coverage, and I do. What did I discover on the phone – Medicare will cover Baqsimi – because my endo wrote a request for prior approval – but it will still cost me $442. What?


Screen Shot 2019-10-07 at 12.42.53 PM.pngNo rep I spoke to knew if Baqsimi was a “Tier Drug” and if it was, what tier it was. This determines the cost. None of them obviously wrote the letter I received so they sympathized with my confusion.  Frankly I’m sure a lawyer wrote this letter so that most anybody receiving it would read the headlines, assume they were denied coverage, and toss the letter in the bin, and their hope along with it. After all, the letter was six pages long. The other five were about appealing the letter’s decision.

In my online sleuthing, I actually discovered that Baqsimi offers a savings card. Hmm…maybe I buried the lead. If you want to sign up for the card look at the grey bar toward the top where it says, “Sign Up.” It’s easy to miss…I wonder why?

If you’re lucky, you might get your first bottle for free. Of course, I don’t know yet if the card will work for me because after I printed it and brought it to my local pharmacy, along with a script from my endo, the pharmacist went into his computer system and it said I was “denied.” There’s a lot of people in healthcare these days really liking this word “denied.” Then in small print it says somewhere on the one page that accompanies the card you that you have to activate it.

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So that’s my next step. Will it work? I don’t know yet. Will keep you posted. Conclusion here.

What character does diabetes play in your life?

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Daniela Rojas above at Dia Vida Diabetes Youth Camp, Costa Rica

It is my great honor and pleasure to know Daniela Rojas. Daniela was born and raised in Costa Rica, is a psychologist, has had type 1 diabetes since the age of 9 and is helping people with both type 1 and type 2 diabetes develop greater emotional strength to manage their diabetes.

I wrote about a diabetes camp Daniela ran, the first of its kind anywhere, on LinkedIn. At this 3-day adventure camp she used my book, The ABCs of Loving Yourself with Diabetes, (the translated Spanish version) as a tool for 70 kids to share their feelings, fears, concerns that a life with type 1 diabetes brings.

Two weeks ago Daniela pioneered again a resource for helping people with type 2 diabetes manage their condition, again using my book. She designed and ran a workshop titled, “Diabetes as a character in your life.” She had 30 participants, men and women, think about the character that diabetes plays in their lives, and read an essay in my book that touched them relating it to how they can put that character in its proper place.

The inspirational essays in the book helped people to express their concerns and bond with one another, and themselves, taking back their lives, with confidence and hope, from the “character” to whom they had given it.


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It’s funny to me that a young woman in Costa Rica is doing this important, essential work while it’s almost impossible to get any funding for the psycho-social aspect of diabetes or even have an institution that would allow interventions such as this for local people with diabetes.

Daniela is creating her own beautiful story. She is touching the lives of so many who are bereft of emotional support and knowing they will come through this. I’m only grateful I can play a small part.

One of the pages from The ABCs of Loving Yourself with Diabetes

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