I have been following a pump supply saga in the Animas Group on TuDiabetes. It first started with a delay in her e-store order from Animas then turned into a change in the amount of supplies that she received. She heard the usual finger pointing that we have all heard, “your doctor” and “your insurance company,” so she was making phone calls to both her doctor and her insurance company. What really put her over the edge was when she was told by Animas that her insurance company would only approve 3 boxes of insets and she was holding a copy of the insurance authorization for 5 boxes. Why is it that a supply company can override what our doctor feels is an appropriate amount for us and our insurance company is agreeable in paying?
I do think that there is a lot of waste in supplies and I even understand why there needs to be limits on supplies. I previously wrote that I think the auto-ship programs create a lot of waste. I often see people say, “the supply company keeps sending me …” and have to wonder why they don’t pick up the phone and tell them they don’t use that stuff. They seem to think it is free because they don’t have to actually write a check for it. After I first started using the Multiclix lancets, I was good about turning the little knob every day but I am back to my old habits. When I call to order test strips, they always ask if I need lancets and my usual answer is no. I went over a year without ordering any and if I keep going at the same rate, it might be another year before I order another box.
This particular person isn’t someone abusing supplies. Her doctor ordered a certain amount and her insurance company approved that amount. She was told by someone at Animas that, “Animas has been audited by the governement and sets can no longer be issued in large quantities” (I copied her quote and left the typo in government in since that is how she wrote it). Her insurance company is not a government plan. Even if her plan was a government plan, she would have the right to have her doctor fill out a medical necessity request and override quantities set by that plan. If that happens, then a supplier should have to honor that override. Prior to her order being shipped, her insurance company authorized a set amount for that order but that authorization was not honored.
Another person wrote she was also going in circles with Animas in getting supplies. Her situation was a little different because she told her account had a credit flag on it. Prior to getting her pump, she worked out an agreement with Animas to pay for her portion of the pump over a period of a year. She was making those payments, however when she paid for her supplies, the supply payments were going towards the pump because it was the oldest balance and making it look like she was not paying for supplies nor did it recognize that there was a plan in place to spread the payments for the pump over a year.
She was told that there was no way to apply the supply payments towards the right invoice. As a former bean counter, I don’t buy that for a minute. If you are going to offer someone a payment plan, then you should have a system in place to honor that plan and not tell them that they can’t get supplies because you can’t distribute their payments properly. Even if their computer system is not setup to handle that, then they can monitor that person’s account the old fashioned way with a spreadsheet. I often had clients that had a special arrangement because of various reasons and I always figured out a way to handle that arrangement – it really is not hard to do.
Pump supplies are not exactly the same as popping a pill every day and your pharmacy counts out 30 pills for you to take. Granted, if you accidentally drop your pills down the garbage disposal, you are going to have a problem, but for the most part, those 30 pills actually last 30 days. With pumps, you can have a bad site, you might have bad insulin and have to toss a cartridge right after you fill it, you might be having an MRI and have to pull the site out early, or you might get your tubing stuck on a door and pull it out. There are a lot of things that can cause you to need a few extra. If your doctor writes the script in a way to make sure you don’t run out of supplies and your insurance company approves that amount, then why should a supply company tell you that you are not allowed to have that amount?
Although having to deal with aggravating attempts at getting supplies was not the reason I stopped pumping, it was certainly on the list of why I didn’t like pumping. We should not have to worry about running out of stuff but it was always a pain trying to order stuff. If I want to buy pen needles, I can do that without a script – having a script only allows me to put it thru my insurance, but if I run out, I can get what I need. You can’t walk into Mom & Pop drugstore and buy pump supplies over the counter if you run out.
This disease is aggravating enough without having to jump thru hoops to get the stuff we need. An insurance company has a right to set rules for getting what we need. If you don’t like that rule, you have a right to appeal. If your insurance company says you can get what you need, a supply company should not be telling you that you can’t have it.