My Hard-Knock Healthcare Wisdom (Tips on How to Navigate the Exchange)

It was about this time last year when I wrote, Battle To The Death.. My Death That Is, about the countless hours/days/weeks I spent dealing with insurance companies. I want to start by saying that I’m incredibly grateful to finally have medical insurance as someone who has been self-employed most of my adult life, but this recent round(s) of phone calls has me questioning a few things.

I was doing some serious number crunching as to how to get the most “bang (test strips) for my buck“. I’m an intelligent woman, in fact, I’ve taken an insane amount of higher education math courses, but this conundrum wasn’t adding up. I had to change how I was going about the situation. After contacting BCBS(OK) for a 17th time in three days, I framed my questions differently so I could better understand.

Here is the scenario I presented to the pharmacy department of BCBS:

• CVS = $394 out-of-pocket ($10 co-pay) for a 90 day supply = 300 strips
• Walgreens = $434. 97 out-of-pocket ($15 co-pay) for a 25 day supply = 200 strips
• Wal-Mart = $366 out-of-pocket ($10 co-pay) for a 90 day supply = 300 strips
  • No Insurance Needed: ReliOn (Wal-Mart brand) $18 out-of-pocket = 100 strips

She explained CVS used to be a preferred pharmacy, but that would end as of 12/31/16. Walgreens was not a preferred pharmacy in 2016, but will be as of 1/1/17. Wal-Mart has always been a preferred pharmacy and has the lowest co-pay. The kind soul at BCBS also added the number of strips per 30 day prescription is dependent upon the language of the prescription. BINGO!

As a T1D veteran and average soul who lives on a budget, I want to share a few tips that helped me navigate the diabetes prescription dilemma.

Overall Tips:

• Keep a log of every conversation (date, who you spoke with, items discussed, etc.) I even write down how long I was on the phone.
• Ask questions. This is your life we’re talking about so no question is dumb or needy.
• Insist your doctor(s) write the correct prescription. Your co-pay is dependent on the # of days supply. In my case, it was 30 or 90 days, but it wasn’t really that simple and is a WHOLE other post.
• If you’re a part of the Marketplace, you can contact your carrier and ask for things. Inquire, inquire, inquire… they will not offer up that information unless you ask.

At the end of the day, I’m truly blessed to have never lived without diabetes supplies. With that being said, I’ve remained an MDI so I haven’t dealt with pump or CGM supplies, which is a whole other ballgame.

We’re all in this together so I would LOVE your feedback on how you’ve survived the rocky insurance waters and came out alive. Your input can help someone else who might not have a clue as to how to make it happen. Knowledge is POWER!