An Update
Friends,
I’ve been lurking and trying to follow the latest threads of
discussion, and to be honest, you guys have me totally confused.
I enjoy the stuff that Jan post the most (IMHO), but several other
folks also impress me as being very knowledgable and well informed.
Couple of things to offer to the list:
1. I now have a copy of "Pumping Insulin", which was one of
the titled recommended to me, have read it through several times, and am
glad to have it.
2. Last Friday, turned from a "_normal_" day to a very crazy
day, when I received a call from home at around 1:00 in the afternoon. The
afternoon mail brough a notice that the HMO to which I presently belong
was withdrawing from the FEBP (my health insurer) as of 1 Jan 2000.
I spend several hours on Friday searching out Health
Insurance brochures, all of which are 1999 (last years) in an attempt to
make an informed guess on which policy to select for the 2000 Open Season,
so I change to another company.
3. My wife, myself, and my son Stephen all spend Friday,
Saturday and Sunday looking at a variety of web sites trying to make a
good decision.
4. We’ve decidided to change to HIP Health Plan of Florida,
which is an HMO (IPPO), and offers benefits similar to what we now have,
the same doctors, the same services, plus some extra stuff I do not now
have.
So, what I’m asking here to see what others have done in this same
type of situation. I work for the Federal Goverment (Federal Employees
Health Benefits Program is what FEHB means), and because of them, do not
have an exclusion clause (which is nice), and the plans offers to Federal
Employees tend to have some better stuff than private sector stuff……
but I’m still curious as to what others have been through.
Please, folks, let’s hear some stories, and whatever else you wish
to discuss
Arnold
June 18th, 2003 at 9:29 am
Hi Arnold:
I know trying to shop for health insurance is a trip, best thing is to look
at what each plan will cover….general health visits to your physician,
seeing a certified diabetes educator and pump training should be included in
your plan as well as nutritionist so you can learn about carbohydrate
counting and how it applies to better control of your glucose. Are you also
covered for physician extenders, like Nurse Practitioners who also do a lot
of diabetes patient management….Gotta plug my future self.
do you have to stay in network in order to be seen, need a referral? what are
the limits on hospitalizations, emergency room visits, and durable medical
equipment which is what a pump and supplies will be…your insulin will be a
pharmacy item…make sure your endocrinologist writes you prescriptions for
each and every item you will need…I’m still waiting for my Pump Therapy
book, I hear it’s a good resource.
After you join whichever plan you choose, make sure there is no gap in your
coverage between the old and the new….they should overlap so that you have
100 % coverage.
Find out also what your endocrinologist does-have a full comprehensive
education and management team? Is he a proponent for pump therapy? that’s
very important. you want to make sure that your health care team is on the
money about pump therapy so you can get the best result for yourself.
Make sure you have a way of getting hold of emergency contact people in the
office when the endocrinologist isn’t there. I had that problem when It was
time to get more pump supplies and batteries…the supplier wouldn’t send or
approve anything without new prescriptions…so infusion sets, syringes, site
preps, dressings, tape, batteries…each prescription has to be specific,
most insurance co. won’t pay for more than a 3 months supply so that means
you want to have enough infusion sets for the flub ups you’ll have when you
first start out…make sure the endocrinologist writes for at least 110
infusion sets total so you always have backup…Has to write to change site
daily….on the prescription, and put a refill 3x on it, hopefully the
insurance company will approve.
And are you covered for pharmacy? Insulin comes under that one…make sure
he or she writes for # 5 vials for use in insulin pump and refill 5x, so you
always have enough
You may also like to have different types of sets so that you can alternate
depth of the site as well as where you can locate it. It will all take about
a month for you to get the hang of it…I’m pretty new at it, only 5 months +
now, but I wouldn’t go back to the old way, my HgA1C is down to 6.7 from
originally 10.0 which is a major accomplishment.
You’ll start to become more knowledgable about your diabetes and how your
body works, what it will do in terms of cooperation and what it won’t…so
much for now…Joan:)
June 18th, 2003 at 5:07 pm
>And are you covered for pharmacy? Insulin comes under that one…make sure
>he or she writes for # 5 vials for use in insulin pump and refill 5x, so
you
>always have enough
…so
>much for now…Joan:)