Diabetes Self-Management Blog

Allow me to continue last week’s drawn-out retelling of "Four Weeks, Fifty Phone Calls: What I Did For A $17 Box of Skin-Prep Wipes."

It’s been a week now since I wrote Part 1 of this blog entry, and in the time between the writing, some of the ire I felt after a two-month runaround has subsided. However, at the end of this piece you’ll read about two new issues that have come to light in the past week to ensure that there will be no shortage of difficulties with insurance providers, durable medical equipment suppliers, or pharmacies any time in the near future.

Let me introduce you to a few of the players in this ordeal:

  • My health plan here at the University of Michigan (where I work) is called Premiere Care and is administered by Blue Cross Blue Shield of Michigan.
  • The prescription drug side of things is handled through a company called SXC Health Solutions Corp.
  • My durable medical equipment (insurance side, related to Premiere Care) is handled through a provider called Northwood, Inc.
  • My durable medical equipment provider, the ones who ship me the actual stuff: Edgepark Medical Supplies.
  • And here’s one other equipment provider that figures into this equation: MedEquip, the U-M’s home medical equipment provider.

I wish you luck if you so choose to wade through the muck that’s about to follow. (I’m warning you ahead of time that it’s fragmented and somewhat difficult to follow — maybe. Imagine trying to watch three or four tennis matches at once.)

When I last left off, I’d received my shipment of diabetes supplies for my insulin pump from my current durable medical equipment provider (DMEP), Edgepark Medical Supplies. Edgepark failed to send me the protective barrier wipes (PBWs); they’d been sending these to me in all prior quarterly shipments, but now they ceased sending.

When I called to ask Edgepark if they could please send some to me, they said they couldn’t: PBWs weren’t covered in their contract with my insurance company, so I’d have to call my insurance provider.

My insurance provider. That’s Blue Cross — also referred to as Blue Care Network (BCN).

I called BCN and explained what happened. BCN tells me I need to call Northwood.

I call Northwood. I give them the same story I just relayed to BCN.

Northwood tells me this shouldn’t have happened. The woman I speak with at Northwood (and by the way, the people at Northwood are friendly and do their best to expedite things) tells me she’ll call someone at Edgepark and get it straightened out.

This was in early February. I didn’t hear back from Northwood.

I also never received my PBWs.

A week later, I get a call from Edgepark: PBWs are not covered under their contract with Northwood.

Umm.

So, Edgepark says, they can ship PBWs to me, but they’ll have to bill me for them. How does that sound?

That doesn’t sound acceptable, I tell them.

So, No, I say. I tell them I spoke with Northwood. Northwood told me they talked with you and cleared it up.

Well, says Edgepark, you’ll have to call them back.

I do.

At this point Northwood explains something to me about the medical contract (I zone out and don’t pay too much attention to this information — not my job to care). Northwood apologizes. They tell me my PBWs can instead be sent from MedEquip.

Great, I say. What do I have to do?

(And understand, reader, by this time I’m invested in seeing how far I do have to go in this ludicrous bureaucratic bit of Ping-Pong to get a cheap box of protective barrier wipes.)

Northwood gives me MedEquip’s number.

I call MedEquip. They say they need prescriptions for the PBWs, as well as for the replacement lancet device that I decided to request as well (the cover on my Accu-Check Multiclix lancet cracked).

I call my doctor’s office and ask if they can fax the scrips over to MedEquip. Please put “Attn: Team 2″ on the fax, I say.

Mid-to-late February. I’ve received nothing in the mail. I’ve also received zero phone calls from any of the players to let me know that something isn’t happening because of x or y. I’m in limbo.

I call my doctor. Or, more precisely, his nurse. (I was in the process of getting my prescriptions transferred over to Walgreen’s mail order [see "Switching Pharmacies Is Hard on the Heart"], so I needed to be on the phone with them for that little travail, because that, too, wasn’t going smoothly).

I ask the nurse about the prescriptions.

Hmmm…Those didn’t seem to get faxed over, says the nurse. Let me do that for you now.

Will you? Thanks.

The next day, MedEquip calls. Hi, they can’t provide me with the PBWs because — get this — I don’t have a contract with MedEquip for all of my durable medical equipment. I don’t have my contract with them?

The way this is explained to me, after phone calls with Northwood, is that because I’m getting the bulk of my equipment from Edgepark, MedEquip may not want to honor the one-time fulfillment of PBWs.

Further, although MedEquip told me they could get me the replacement lancet device, they’re now telling me they can’t. (Although it turns out I could just call the manufacturer and request a new one, free of charge. That job: done.)

I call Northwood. The person I speak with regarding my PBWs, after I explain what’s going on, says she’ll call Edgepark and work it out so that they get reimbursed for sending me the PBWs, that I should have them soon, that we can get this cleared up.

End of story, right? Not quite.

A week later I get a package in the mail from Edgepark. Barrier wipes! Yay!

No. I open it, and inside are, loosely packed (not in a box), about 50 alcohol prep wipes. Umm. Not the same thing. I needed protective barrier wipes.

I call Northwood. Run through the whole thing. Ask what’s going on. They say they’ll call Edgepark.

Ten minutes later, I get a call from Edgepark. What was sent to me? I tell the guy that it was a hodgepodge of alcohol prep wipes.

Oh. He tells me it was because the PBWs weren’t covered and that they were just sending me samples, but the guy must have put in the wrong samples.

Must have.

But I’m also confused. Northwood told me they were covering those PBWs.

No, says Edgepark guy. It seems that’s not going to happen.

I call Northwood. Rehash.

Northwood now tells me they’ll call MedEquip and have a box of protective barrier wipes shipped to me regardless of the contract status and who it is I get the bulk of my medical equipment supplies from.

Oh, and by the way, says Northwood, effective May 1 you’ll be transitioning from Edgepark to MedEquip for all of your durable medical equipment.

What?

Northwood is shifting their Premiere Care patients to MedEquip.

My heart sinks. Seriously? Do you have any idea the difficulty I had making the transition from my previous durable medical equipment provider to Edgepark? It took months to get things ironed out!

I just sigh, say thanks, hang up the phone.

Two days later I get my PBWs, but there’s no cause to celebrate. I know the trials and tribulations to follow.

Then, yesterday, I learn that Smiths Medical, the maker of my insulin pump — the Deltec Cozmo — is discontinuing selling the pump and diabetes supplies.

Just joy. Sheer joy. And despite the promise of smooth transitions to whatever is next, so
mehow I don’t feel my spirits soar.

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Insurance, Skin-Prep Wipes, and Principle (Part 1)
Insurance, Skin-Prep Wipes, and Principle (Part 2)


Comments
  1. Eric,

    Not a plug, but Medtronics is pretty unified. Propriatary pump gear and all supplies in house. I get the infusion sets, reservouirs, barrier wipes all from them. I also get the sensors and the transmitter kits from them. They are deeply embedded in a variety of insurance companies and doctors offices (mostly a good thing, I guess) and they always handle any insurance issue for me very promptly. For me, fast and effective service is extremely value. It is a tradeable cmmodity. I have enough to keep my mind occupied with diabetes and living. Cross corporate administration is a jungle of confusion and tangled lines. Just as I try to orient my life so that I am going in the opposite direct of traffic jams, I orient my providers the same way.

    Medtronics is the largest company, I believe, and I think they leverage it well.

    There may be others out there as good. That’s just my personal experience.

    Posted by Peter Mead |
  2. Having been through this several times, what you need to do when you call up, for example, Edgepark, is have them do a three-way call with the insurance company while you’re on the line. It seems to be the only way to get everyone on the same page.

    Posted by Lili |
  3. Eric,
    I work for North Carolina State University and our state health plan is run by Blue Cross Blue Shield too. Although I am not in the same predicament yet, I feel your pain brother. Our state legislature is fighting over budget cuts and deciding on the changes to our health care plan. Well that’s another battle we will all have to fight. Good luck.

    Posted by mistervegas |
  4. If you think that this is a nightmare (which it definitely is) wait until Uncle Sam gets REALLY involved in healthcare.

    As bad as insurance companies can be, just think about the confusion and efficiencies of such government agencies as Congress and the Post Office.

    Posted by phlsyes |
  5. I’ve gotten the same sort of run-around. I’m on Medicare, with a Part D prescription plan through Blue Cross Blue Shield. My Dr and I decided to try me on Salsalate. There have been a lot of articles about this drug lately. Its an anti-inflammatory but has been shown to help lower blood sugar levels as well.

    First month, I paid for the script because it wasm’t on my insurance formulary. I called the company and was told my Dr would have to request a Formulary Exception to get it covered. She sent the form. Nothing happened. I called again, got a different person who told me it wasn’t approved because it was on Medicare’s proscribed list.

    Okay, I called Medicare. All I got was a repeated quote of possible reasons for proscription, nothing specific to why this med wasn’t covered.

    I gave up. If Medicare would rather spend over $200 a month on a Celebrex prescription plus another $200 for Januvia instead of spending about $20 on Salsalate to replace both of those, I can see why its going broke.

    Posted by Ephrenia |
  6. Sympathies! Empathies! OMG!!! I’ve been through this run-around — with medical suppliers not even following their own “rules” a number of times.

    They do this so we will not bother them with our legitimate requests that they meet our contracts and legitimate medical needs.

    Now, with Medicare thrown in the mix it’s even worse.

    MEDICARE DOESN’T PAY DIDDLEY!! Of my first 2 claims for ‘09 totalling $180.01 Medicare paid a whopping total of — are ya ready for this??? — $9.93

    And I still face dealing with the change in my Medicare Part D provider — O I can hardly wait.

    I don’t know if being part of a large group helps — but it’s happening to all of us.

    Do you think maybe President Obama could help us deal with all this UNnecessary stupidity and corporate lack of responsibility.

    So again, Sympathies! Empathies! all those “ies”.

    KT

    Posted by KT556 |
  7. I feel since I am covered by insurance and a supplement there is no reason to fuss over purchasing my own preps and lancet devices if one breaks. Walgreens has a pretty reasonable device. I also do not object to furnishing my own lancets. Lancets are covered under my insurance, but hey are not expensive. The test strips are. Granted I pay for my insurance coverage….however I am not about to quibble over a few dollars to help myself and not look to Medicare or my supplement to pay for everything. This of course is my own opinion.

    Posted by granny Pat |
  8. I am on a Medtronics insulin pump and had been getting the supplies directly through the company until April 1, 2009, when they were forced by Blue Cross to go through MedEquip. The prices that MedEquip is trying to charge me for the exact same supplies I was getting directly from Medtronics is more than THREE TIMES as much! It’s ridiculous. And now Blue Care Network doesn’t want to cover such high prices, so I’m going to be stuck with much higher co-pays.

    I swear the insurance companies just want us all to die and get off their backs……..

    Posted by sweetie5365 |
  9. This email pertains to an insurance issue but not the same problem as you have. I’m trying to help a friend of mine. Her insurance denied her request for a Guardian Real-Time Sensor System and I’m trying to find someone who is using this unit and how they were able to get their insurance to cover it? She has type 1 diabetis, is in her 50’s and does a good job of taking care of herself but recently she’s having some problems. Her Dr. verified everything with the insurance company.
    Do you have any suggestions or know anyone who is using this unit?

    Posted by DL |
  10. Eric,

    I’ve had a pump with Medtronic/Minimed since 2000, and their customer service has been nothing short of stellar for me. They handle all the billing, insurance, etc., and are pretty up front about which things may or may not be covered.

    They have automatic shipment if you want to use it (I don’t now, but I have, and it’s painless) and they have awesome device support 24/7.

    They also have a continuous glucose monitoring system which is great (but, truthfully, still has a few kinks).

    I think you’d be happy with Medtronic/Minimed. I agree with Peter. They are top notch.

    Posted by L Beach |

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