More Questions?

I've had way too much time on my hands being snowed in the last few days. I'm thankful I had time to do some "homework" and save us money for Kacey's insulin but now I have another question.

As I shared in an earlier post, we got the pump approval and we will have to pay a balance of $1060. The more I thought about this....the more I started to stress (and I'm probably stressing over nothing...but don't want to wonder about it). We have United Healthcare insurance and we have a cap for Durable Medical Equipment of $3500 a year. Since it is the beginning of a new year and we are using that $3500 toward a pump, what happens with the pump supplies? Are they covered under DME or are they covered under the prescription plan? Is there a way to have that cap removed or increased since the pump is what is using it and we only upgrade every 3-4 years? I'm worried that her pump supplies are not going to be covered now. I tried talking to the UHC rep on the phone and it was obvious he didn't know diddly-squat about what I was talking about and insisted that I should "RENT" her pump and supplies. Whattttttttttt? Rent something that is going to be attached to her 24/7 and parts of it are disposable? I don't think so! I asked the UHC rep about having the cap removed and he said there is no way they can do that. He told me I had to call the person who sold my husband's company the insurance and ask them. So I called the lady at my husband's work that handles the insurance stuff and asked her and she told me that they get the insurance stuff sent down from corporate and she has no clue who the UHC rep is or how I would go about getting my questions answered. Ugh! So I'm stuck!

Is there anyone experienced with insurance questions? Can anyone help me with these questions or tell me how I'd go about finding out the answers?

I'm sitting here stressing because once she gets this pump, I don't want to be stuck not being able to afford the supplies for it.

More Changes

Because we are snowed in, I had no way to fax blood sugars this morning. Last night, Kacey's numbers went haywire! I noticed her downing a glass of water and asked her if she felt ok. She said she did but she was very thirsty... blood sugar check, please! The meter said....YIKES! Her numbers haven't hit the 300's in a while! Hmmm...think Jill, think! Ahhh it's 2 hours post meal. Looks like a possible dose change because her body must be back to "normal" since the flu. We pushed more water and tested an hour later. The meter said.... HOLY HIGH NUMBERS BATMAN! What in the world is going on? Geesh! So we tried more water...and waited...she dozed off and I tested her at 10pm. The meter read... 220 mg/dl. So I knew I could catch a few hours of rest before I had to test again. Set the clock for 2am... tested... 180 mg/dl. Whew! I can sleep :) This morning she woke up at a 168 mg/dl. She did fine at breakfast but 2 hours post lunch was a disaster! She was screaming she was hungry and very thirsty. Test again, please! The meter read..... Thats it! I gave her more water and called her CDE. I explain whats going on and tell her since we're snowed in I couldn't fax blood sugars but a dose change was needed because she was hitting the 300's. I asked to change it back to what it was before she got the flu since obviously she was all better and her body was telling me it was...LOL! She agreed to change it back and see what happens the next 3 days. While I had her on the phone, I asked her about NovoLog vs. Humalog and she had no idea why our prescription was written for Humalog if we were on NovoLog in the hospital. They usually start you on what the preferred insulin for your insurance it. In our case, NovoLog is cheaper and thats what we were started on but somehow ended up with a prescription written for Humalog. The NovoLog pens are a 2nd tier instead of 3rd tier...$30 instead of $50!! Once we start using the vials then it will only be $15! Wowwwww! Thats a HUGE savings for us :) Guess I'm glad I did some research on our insurance's website otherwise we never would have caught it.

Now if I can just figure out how much pump supplies are going to cost us?!?!

Health Insurance

Health insurance has become a top priority in our life the last 6 months. Some days I sit and think about how we'd manage if we didn't have it. I know Frankie makes too much to qualify for any type of state assistance. We tried to get help for the $160 a month we have to pay a month for insulin & supplies and we were denied. I personally think it's really sad that we're busting our asses to make ends meet and we already pay almost $500 a month just for insurance, not counting co-pays and medications. I wanted assistance for the $160 we have to pay for insulin and diabetes supplies because I didn't want to have to worry about where the money would come from if we happened to come up short. I explained things to the lady and told her without insulin Kacey would die and she looked at me and said "Mam, I really am sorry, but your husband makes too much a month and there is nothing we can do to help you." The system SUCKS! There are people we know that are mooching off the system, lazy bums who don't give a flying flip about their kids, and they go to the doc for every ache & pain and get pain meds and then turn around and sell them for CASH! WTF is wrong with the system?!?! Grrrrr!

OK...so all that being said... I'm in a bit of a dilemma. Frankie's company isn't very stable right now. They've cut his hours to 40hrs a week. He went from working 60hrs a week to 40hrs a week....20hrs of time & a half....CUT! They've told them that NO ONE will get overtime for any reason. This really got me worried. So as things would have it, the job he applied for a few years ago with the city has now opened back up and he was called for an interview. He went for the interview and things look really bright and this would be a stable move for us. My biggest fear was switching insurance. The first thing he asked them was would Kacey have a waiting period for a pre-existing condition. Since we already have insurance then she will NOT :) Our insurance is nearly $500 a month now and we have United Healthcare. We will be getting Anthem and it will be $232 a month....thats HALF of what we are paying now! Right now we pay $20 for reg doc visits and $40 for specialist and with the new insurance it will be $10! So thats another savings. Same with medications...we will pay a significant amount less. Now here's my dilemma...I filled out all the paperwork for Kacey's pump to go through our current insurance which will pay 80%...leaving us paying $1200 or so for the pump. But I'm not sure what Anthem covers for the pump? I've heard 100% and I've heard 80%. If they are going to cover 100% then I'm thinking it will be in our best interest to wait another month or so before filing all the paperwork. I don't have the heart to tell Kacey this because I know how badly she wants the pump and how badly I want it for her. I'm just trying to figure out what our best interest would be to keep us from being stuck with more medical bills. Sometimes we have to think with our brains instead of our hearts and this is one of those times I'm trying to use my brain.

Does anyone have Anthem? How is the coverage?

I'm really scared to make this move but I'm scared if we don't make this move and the company Frankie works for decides to go under then he's without a job and we're without insurance and then we'd REALLY be in trouble. I need some advice here because I'm unsure and stressed over all of this! It's weighing heavy on me right now and I'm torn on what decision we should make.