Insurance companies who don't follow prescriptions

By cedarwolf Latest Reply 2010-02-02 10:45:05 -0600
Started 2009-04-04 12:39:38 -0500

I have a state medical insurance policy because I teach. Our state insurer has decided that it doesn't matter what the doctor writes for diabetes prescriptions and equipment, they only like the two most expensive readers and strip products, and they, not the doctor, will decide how many strips you can have per month. The co-pay is almost as much as an outright purchase. Anyone else having problems such as these?

14 replies

xena 2010-02-02 10:45:05 -0600 Report

thanks to my doctor i used to get my strips for free, i dont know if he new about the insurance companies not paying for diabetic supplies or not, but that was a good thing because i know how expensive the test strips can get. it has been over two years since i have tested because of my old one quit working even with new batteries in it

BeckyJ 2010-01-16 15:25:34 -0600 Report

Thank God my insurance just changed. Prior to now they would only cover 3 strips a day, regardless of the meter used, and that only becuase I am insulin dependent. If you are just on pills they only covered 1 a day! They would only authorize a box of 100 every 33 days. The doctor wrote the prescription out as 6-8 times daily so that actually equals 180-240 a month. It didn't matter! I have to use the Breeze or Breeze 2 meters since those are the only ones that connect to the doctor's office every time. Tried other meters and sometimes could not get them to upload. I have to report my numbers every week so a meter that didn't upload meant typing every number into the computer manually and the nurses hated me for it. Now I get 2 boxes a month no hassles. I pay a higher co-pay but it's still cheaper than out of pocket like before. Really, do they really cost a dollar a strip to manufacture?! Come on. BTW, this was Medicare that has changed not an individual health insurance!

PANTOUS 2010-01-23 05:39:39 -0600 Report

My insurance just chaged too, not only do I have to find a new diabets doctor, but I had the same problem about the strips,they only pay for one machine. But I had my doctor write a letter to the insurance company saying it was needed for me to check my blood 8-10 times a day. When they got that they approved all the strips. I get three months for the price of two threw the mail order company. I like doing that cause I save money and have enough strips. I do miss my old machine, it had a nice light, the new one don't have a light at all.
But good luck. If you ask your doc. to write a letter too it might be approved for you.

Zimoss 2010-01-16 12:57:46 -0600 Report

my favorite is when the Pharmacy won't follow the doctor's guidelines. I used to use the local national chain pharmacy and they would follow the prescription, but only fill with enough to last 26 days since I could get a refill after that… i finally got tired of getting gouged and changed pharmacies and never had a problem since.

Mom and boys
Mom and boys 2009-04-14 11:49:05 -0500 Report

LORD … time for me to follow through. I have been paying for my strips because I did not think insurance paid for them! I will be doing some resarch :)

TwoHugs 2010-01-23 04:43:44 -0600 Report

Please let me know what you find out. I can't even get health insurance for my needs.
Thank you Laurie

roger 2009-04-13 20:13:36 -0500 Report

my dr presciptions for strips is 200 they will only give me 150 so i cant test as many times a day as my dr wants ?

kdroberts 2009-04-14 07:35:29 -0500 Report

Are you sure they are giving you 150 per 30 days or for another amount? My prescription is for 6 times a day which would be 180 per 30 days. Since test strips don't come in boxes of 180 the pharmacy runs it as 100 for a 15 day supply. That way I actually make out in the long run by getting 200 strips per month rather than 180. Could it be that something similar is happening to you? Just ask your pharmacy and see how many days supply you are getting. If you really are getting short changed, ask your doctor to submit a prior authorization application to your insurance company, that way you should be able to get 200 per month.

roger 2009-04-19 09:39:16 -0500 Report

the dr was very upset the last time i pointed this out to her she is looking in to it for me but told me it happens a lot that is all they will pay for

kdroberts 2009-04-13 16:01:48 -0500 Report

hat's how health insurance works. The insurance company decides what and who they cover. The customer (in your case your employer) decides what they will pay and the insurance company comes up with policies for them. If you want to see what's covered you need to check your insurers formulary. The two most covered testing supplies are accu-chek and one touch. Unfortunately you have to go with what your insurance says. Depending on who is making the decision to not cover the strips, the insurance company or your employer, you may be able to get it covered and at a higher rate. I know that my insurance company will only cover 200 strips a month but with prior authorization they will cover what the doctor says. However, you need to prove a reason why, insulin use is a good one. However, if your employer is deciding the coverage, you have no options.

Anonymous 2010-01-20 20:44:40 -0600 Report

There are sometimes appeal processes and pathways for exceptions being approved for coverage when it is through an employer. Talk to your employee benefits coordinator (may I suggest). I help employees when they speak up about issues concerning coverage under the plan. Good luck!

Desdemona 2009-04-13 15:14:27 -0500 Report

Yeah- I had to change insulins to avoid a $100 copay. They also are providing OneTouch strips for free, but Freestyle strips have the $100 copay. Since I use an Omnipod, it's aggravating to have to carry 2 meters.

Judimar 2009-04-04 15:58:27 -0500 Report

I had my insurance company send me a monitor they "sanction" but the cost of the strips were not much different. Now we had to change insurance providers due to the company my husband is now employed has changed. He is a government contractor and the company who bought the contract he is working on changed.

Since the change is recent I am holding my breath to see what changes await me. One of my concerns is that the meter I used will no longer be "covered" by the new insurance provider. What a huge headache but as sparkysmom stated, it's better then no insurance.

sparkysmom 2009-04-04 13:53:46 -0500 Report

Yea my insurance only allows me 100 strips a month. Pretty bad when Dr wants me to test 5-6 times a day. They are at the high end of my pharmacy too. Better than no insurance but I sure would like to know why the limit. also they sent me the monitor they want me to use. If I use the one I like I have to pay for strips.

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