Insurance Lunacy

While waiting for my shin splints to heal, I am not running, but am sure getting plenty of run-around from my health insurance.

I started my insulin pump 8 months ago, getting approval and coverage shortlly before I left me previous job. It has not taken long to understand and use the pump efffectively.

However, in this 8 month time span, I have been unable to get true clarity or meaningful answers from Humana on the coverage of the pump supplies (the cover the insulin, the question is on the reservoir (a container) and the infusion set (a tube with a needle), in function exactly equal to an insulin syringe.

As syringe is covered as a $10 co-pay. However, while Humana covers the Paradim reservoiir as a perscription item at the same $10 co-pay, it provides no coverage at all for the infusion set. What good is one without the other? Hello? Is there any sanity there?

Then there was the 3 month period where the Humana web site’s perscription tools would not work for my account to even confirm my coverage. It took 4 email messages, 3 phone calls, 3 months to get them to fix their database.

But its more complicated. If I order my supplies from Medtronic directly, which does get a prescription authorized form my doctor, Humana covers only 10% of the total costs, because Medtronic is a provider of “durable goods”. My last 4 month supply cost me out of pocket $440.

So with another round of phone calls, I find out that if I can take my perscription to a place that can fill them as a prescription item, Humana will cover the reservoir at the $10 co-pay. And with some more querying of the Humana rep, I was told that I might get an “exception” to the no coverage on the infusion set, if I can have my doctor talk to their Calims Review department.

My doctor, my pharmacist has never heard of needing to go anywhere else but the supplier to get this covered (the pharmacy had to even look it up on the Walgreens system as he has never had to fill such an item). And my doctor has to waste time nagging my insurance company?

This just seems total stupid lunacy to get reasonable access to needed medical supplies — how much saving are they doing in the long run, if insurance companies make irrational coverage decisions that induce people not to get proper health care?

Crazy, I say. Stupid crazy.

2 thoughts on “Insurance Lunacy

  1. Hi Alan! I was checking up on your running progress. Looks like you are kicking butt!

    I don’t know if this will mean anything to you, but my husband used to work for St. Joseph’s hospital, and for a long time at a hospital in Chicago before that. He managed their data systems. When I left Maricopa he insisted we buy BCBSAZ insurance. He said of all the health insurers, there’s was the least hassle in terms of getting stuff covered and getting the claims paid.

    Good luck training!


  2. Oh I agree that BCBSAZ is a great plan. My current plan (Humana), is provided by my new employer, and costs much less than out of pocket insurance (well, exce3pt maybe for the hassle). Actually, there are some things they do very well — their online tools and records are much better than I recall from BCBS.

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