UnitedHealthcare Loves Diabetics

[rstonepal]

I woke up to an ugly bit of news today. Our insurance provider, UnitedHealthcare, and which is also one of the largest providers in the United States. UH announced they will no longer allow Pump eligible T1Ds to choose which insulin pump would work best to keep them alive. They will still allow us to get our supplies just no replacements or upgrades. We must buy a Medtronic MiniMed pumps ONLY.

I was on a MiniMed for 15 years and I really liked it. When I started losing my eyesight to the cataracts, I could not see the Medtronic screen. From what I hear, they have changed the screen to be colorized, which helps. My personal problem and dislike of this,,,,Medtronic makes lovely pumps,,and cardio equipment, every device I have gotten from them to check my sugars has not worked to my level of necessity. I do not wish to go back to jabbing my fingers every hour just to make sure my CGM is reading correctly. And it is not like my Dexcom which calibrates within a few numbers. Oh no, my medtronic would read 333 when I was actually at 103 or vice versa. I called them repeatedly, they kept re calibrating and resetting it. I never got a correct read.

Late last year, UnitedHealthcare removed my insulin from their formulary. I am no longer able to get Novolog and MUST use Humalog. I had to go through a bunch of tests 12 years ago to find, I do not do well on Humalog. I have a perpetual sunburn on my skin, it is on fire. My hands are always hypo, no matter what the reading is, and I am so weak, I have to hold onto things to stand up. I can buy the vial out of pocket but after they signed the contract with UnitedHealthcare, they raised the price of the insulin from 163.00 to 225.00.

This goes back to my main gripe about the medical industry, they do not listen. If they did, we would have a lot less of us needing to use their services. Ahhhh, money...

 

[KevinPotts]

rstonepal, as a Brit I find your story both sad and overwhelming. As a beneficiary of the wonderful NHS, albeit, with its niggles and flaws, I am so grateful, that irrespective of my means, medical care is free at the point of need. The GP can work with us over here and will prescribe what will work optimally for you the patient. Sending you my best wishes and hoping that some way you can find a path through to satisfaction.

 

[rstonepal]

rstonepal, as a Brit I find your story both sad and overwhelming. As a beneficiary of the wonderful NHS, albeit, with its niggles and flaws, I am so grateful, that irrespective of my means, medical care is free at the point of need. The GP can work with us over here and will prescribe what will work optimally for you the patient. Sending you my best wishes and hoping that some way you can find a path through to satisfaction.

We tried fighting the decision, explained how structurally the two are different and that is where my problem stems from. Plus, with the stomach paralysis, I can dose more efficiently with the Novo. With the Humalog, it seems to hit whenever it wants, that was another problem with the insulin. We thought we won in December when my Endo prescribed Nololog for my refills. I just got an invoice because my Endocrinologist is not authorized to write the prescription.

 

[Kristin251]

We had UN and my prescription went from $70 to $600!! They suggested I change insulin. Like it's all the same. Idiots. Luckily for me the prescription lasts me 5 months but still ridiculous. I talked to my endo and he hates homologous and levemere. Says they are unpredictable and I would need much higher doses so in the end would probably work out the same cost wise. I know my insulin like the back of my hand as much as you can. I'm not willing to change yet. UN stinks!

 

[KevinPotts]

Kristin, $600 for an insulin prescription....flipping hec!

 

[catapillar]

@rstonepal i saw this mentioned in a facebook group & someone said they had rung United health and been told that this notice wasn't correct/genuine but could be a phishing scam to get you to put personal details into fake United health websites. I have absolutely no idea whether that is correct or not - I'm on the UK and have no clue about health insurance - but I just wanted to mention it in case ringing them would provide any reassurance for you, it's gotta be worth a call to check. Sorry if I'm just being over optimistic...

 

[TorqPenderloin]

If you haven't already, submit a prior authorization form for medical necessity. I had to do that three times before it finally went to 3rd party arbitration which was approved....and that was only to use my Accu-Chek Aviva Expert meter instead of my old OneTouch Verio. Oddly enough, my insurance would have covered the test strip but only if I was on the Accu-Chek insulin pump (which they would have paid for, go figure?)

Also, if you haven't already get your current pump manufacturer involved. Roche's (maker of Accu-Chek) local rep helped my doctor submit the necessary paperwork AND she also sent me free test strips while we were fighting insurance.

If you have a good doctor, it shouldn't be hard to fight this. Especially, given your success on your current pump and your eyesight issues you mentioned.

 

[Kristin251]

Kristin, $600 for an insulin prescription....flipping hec!

That is for both lantus and novolog but I was used to paying $70 so quite a shock. I can't imagine if I needed larger doses and the pens didn't last a full month. This disease gets you every way you turn.
My husband changed jobs recently as did the insurance of course. Still in a better position but still.....

 

[rstonepal]

We had UN and my prescription went from $70 to $600!! They suggested I change insulin. Like it's all the same. Idiots. Luckily for me the prescription lasts me 5 months but still ridiculous. I talked to my endo and he hates homologous and levemere. Says they are unpredictable and I would need much higher doses so in the end would probably work out the same cost wise. I know my insulin like the back of my hand as much as you can. I'm not willing to change yet. UN stinks!

I love you! Do you ever wonder why docs want to convince us we are wrong and do not exhibit what we live through when the doc is not around and they cannot see it happening? At this very moment my sugar is at 114. I am happy with that number and should be feeling great. I feel panicky hypo. Stupid Humalog.

 

[rstonepal]

I woke up to an ugly bit of news today. Our insurance provider, UnitedHealthcare, and which is also one of the largest providers in the United States. UH announced they will no longer allow Pump eligible T1Ds to choose which insulin pump would work best to keep them alive. They will still allow us to get our supplies just no replacements or upgrades. We must buy a Medtronic MiniMed pumps ONLY.

I was on a MiniMed for 15 years and I really liked it. When I started losing my eyesight to the cataracts, I could not see the Medtronic screen. From what I hear, they have changed the screen to be colorized, which helps. My personal problem and dislike of this,,,,Medtronic makes lovely pumps,,and cardio equipment, every device I have gotten from them to check my sugars has not worked to my level of necessity. I do not wish to go back to jabbing my fingers every hour just to make sure my CGM is reading correctly. And it is not like my Dexcom which calibrates within a few numbers. Oh no, my medtronic would read 333 when I was actually at 103 or vice versa. I called them repeatedly, they kept re calibrating and resetting it. I never got a correct read.

Late last year, UnitedHealthcare removed my insulin from their formulary. I am no longer able to get Novolog and MUST use Humalog. I had to go through a bunch of tests 12 years ago to find, I do not do well on Humalog. I have a perpetual sunburn on my skin, it is on fire. My hands are always hypo, no matter what the reading is, and I am so weak, I have to hold onto things to stand up. I can buy the vial out of pocket but after they signed the contract with UnitedHealthcare, they raised the price of the insulin from 163.00 to 225.00.

This goes back to my main gripe about the medical industry, they do not listen. If they did, we would have a lot less of us needing to use their services. Ahhhh, money...

Now this is just getting ridiculous. I have been a supply horder all my life. I do not have thousands of supplies but I do have enough to hold me over in case I cannot get them when I do need them. I got an alert that it is time to order my Pump supplies. It is time so I placed the order, a month and a half ago. I just got an email telling me my supplies are no longer covered. How in the world is this acceptable?

 

[KevinPotts]

Oh dear, that is terrible. Can you appeal as suggested in one of the responses yesterday? I really feel for you.

 

[tim2000s]

It's interesting isn't it? Restriction of available solutions through an insurance provider is a perfectly normal thing for an insurer to do and a normal consequence of an insurer looking to reduce costs to improve their profit. Whilst it might seem unethical, they aren't removing access to pumps from their policies, just improving their position as a business by saying we don't want to pay out for all this choice.

While you won't get a vast amount of feedback from UK T1s on this, as that kind of choice has been lacking in many parts of the UK for a long time due to the different model we have, it's an unsurprising result of the US healthcare system too.

The best "system" really is somewhere between the two.

 

[TorqPenderloin]

Another thing to consider too is the difference between insulin, which is usually covered under your Pharmacy Benefit, and things like a CGM or insulin pump which are usually considered DME (durable medical equipment) and covered separately.

Furthermore, most insurance companies should have a list of what is covered. The coverage is often separated between generics which are "Preferred" and "Non-preferred."

Usually a pharmacy benefit won't have agreements with every single manufacturer which means you won't have a a choice between every option on the market. However, it would be a choice between Humalog vs. Novolog and for most people either would work.

Considering that Novolog and Levemir retail for about $100 a pen without insurance, I'm guessing Kristin's $600 prescription wasn't covered at all. I'd be curious to review the pharmacy benefit of that plan to see what was and was not covered. Again, even if something isn't listed, that doesn't mean you can't get it approved.

This is pretty complicated stuff and I agree that insurance companies are a pain in the a**, but you can save yourself a ton of time and money by understanding your complete health benefits and how to maximize the savings on them.

 

[Kristin251]

The $600 was for both lantus and novolog. 5 pens each. It is new insurance although it just changed again, and we weren't prepared for the increase so we just got it without doing research. Sometimes I don't have the energy or inclination to fight this beastly disease and that was one of those days. I should have though. I'm sure I would 'live' on humalog but I know novolog like the back of my hand as much as you can know insulin. I don't want to change so I will pay the extra. I just got settled into a good routine and diet plan and don't want to rock the boat. I just think it is ridiculous that insurance companies just want to you switch meds around that act differently. Insulin saves our lives and it can kill us if not used correctly. Not interested in playing that game, at least not until I have to. I'm curious as to what this new insurance is. My hubby thinks it will be similar. Boo