Diabetes Self-Management Blog

Know why medical insurance costs are rising so much? I think I have the answer: They don’t always care how much they pay out.

Let me throw out some numbers to you. I got a new insulin pump in December and (hurray!) the one I selected was available in-network. Less money for me to pay out, right?

OK, right. But (a big but), my insurance provider is paying more than I believe it should be for pump supplies because the medical supply company it contracts with for that is charging usurious rates.

It all started because the supplier apparently doesn’t carry the infusion sets I prefer, which come in a box of five full sets and five infusion sets only. It only carries boxes of 10 full sets. I ordered one box to keep me in supplies for a while and began to look around at what other places charged.

As a point of reference, my supplier charges $242.82 for the box of 10 full sets. My pump company charges $110. Another pump company charges $102.50.

For the 5/5 combo that I prefer, the supplier lists a price of $233.45 at its online store (although it contends it does not carry them). My pump company does not carry them and does not list them on its company store. Another pump company charges $87.

After I paid my co-pay for that one box of infusion sets, I was billed for an additional $102.95 because I hadn’t met my deductible. I don’t know if my insurance company paid anything on it or not. However, I thought as I scratched my head, my insurance company could have paid the other pump company full price—without charging me a co-pay at all—and still have paid a few cents less (assuming, of course, I had met my deductible) per box. With my co-pay, it would have come out several bucks ahead.

Of course, I’ve been trying to reach the university’s rep at the insurance carrier that covers supplies so I can tell her they’re paying too much. Have I gotten a call back? Ha! (In fact, even the school’s staff benefits person says she has trouble getting a response from the insurance carrier’s rep.)

I think it would be nice if insurance companies would give us a bonus for seeking out lower prices for them—even if it’s just to pay 100% if we can show it will cost less to pay full price than pay their percentage. But that’s not likely to happen. The carriers can charge what they will and they can pay providers whatever they can work out: It’s the employers (and employees) who continue to see their insurance costs rise because the bean counters at the insurance carriers don’t seem to be hurting a lot.

Why should we care? Having insurance means we don’t have to pay the full freight, right? Ha! We’re paying, all right, in increased premiums as companies put more of the insurance cost burden on the employees and in decreased wages because of rising insurance costs to the company.

Besides, paying a higher price for supplies means I’m paying more out of pocket for my co-pay.

We’re also eating into our lifetime caps. I don’t know about your health insurance policy, but mine says it will only pay up to “X” amount of dollars over my lifetime. If I ever have a catastrophic disease, it’s likely to be even more expensive than diabetes. I like to think that, by saving a few pennies here and there, it will add up to several dollars in savings to be used in that unknown future.

While it’s bad enough not knowing what’s going to happen in the future, it’s even worse not knowing how to remedy something I know that’s happening today.

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Money Matters
Money Is Strong Diabetes Medicine (08/20/14)
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