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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Comments
  1. Dear Jan. Are insulin pumps worth the very great expense and hassle compared to seringes and long lasting insulin like Lantus combined with a fast acting one for feedback(i.e. BG too high inject 1 or 2 units and remeasure 1 hour later add more if need be, not forgetting that there is still insulin action to be had from the previously injected one) and feedforward control ( i.e. I am going to eat 100 grams of pasta or 3 slices of bread in the near future so I will inject 5 units of insulin. to reduce the BG increase that will happen if you do anything My HA1C was 6.4% if you got it down to 5.5% with the pump is this worth it? Plus where do you tape the pump for sleeping?

    Posted by Calgarydiabetic |
  2. Insurance is a maze of seemingly nonsensical rules and regulations. The real key maybe budgetary considerations

    Some years back my mother had some bypass surgery, the bill was $25000 or so, Medicare paid $2500 that’s right about 10% the rest was written off.

    I had insurance that covered a podiatrist who charged $70 for routine foot care. Of the $70 he got $20 from insurance and $20 from me. Now without insurance he wants $50 from me for the same care he is billing the insurance for and collecting $40. Seems I need to re negotiate that fee arrangement.

    My MD charges about $270 for a periodic visit which the insurance and I pay about 55%. The insurance pays whatever of the 55% is left after my $20 copay. If I pay him cash for the same service the fee is $75.

    So if the insurance company is willing to give my MD a raise of say 10% per visit then they would raise the starting price about 20% because they aren’t going to pay more percentage wise. So in my MD’s case the new charge would be about $340

    Raises the question, who really pays the retail price? From my experience with an uninsured hospital stay starting in the emergency room the uninsured patient is charged the full price.

    Go figure, but don’t lay all the blame at the feet of the insurance companies. I believe the rates are set based on what Medicare will pay for a medical procedure.

    Posted by Uncle Buck |
  3. Jan, your first paragraph says it all — they just don’t care –and neither do the medical facilities that they partner with to make extra millions from people like us.

    A few years ago, I went to the hospital for a morning out-patient procedure. I had been fasting, and had to remain in bed for a few hours afterwards. A nurse offered to bring me a lunch tray and I reached for my purse to take my oral meds. At that time, I was not yet on insulin, and my blood sugars were very much in control.

    The nurse saw me about to take medication and told me that I could not do so because any medication while hospitalized had to come from the hospital pharmacy.
    Remembering a prior incident when I was charged $15 for a box of KLEENEX, I told her that I would have lunch and take the meds when I got home. So, about 30 minutes later, she brought the lunch with the meds (which she had looked-up) on the tray.

    I told her, again, I did not want the meds and she took them away. I asked her to make sure that they would not be charged for. When I left the hospital, I repeated this request to the outpatient supervisor. Well, lo and behold, a month later when I received the bill, there was was a total of $60 charged for six pills ($10 per pill).

    After spending about a week on the phone trying to find the person in the hospital who dealt with such matters, the accounts payable supervisor’s reply was, “Why do you care — the insurance company is paying for it.”

    It is outrageous that everything related to the workings of our present-day medical system is based on huge profits — and many of them in the form of “payoff’s.” Just talk to anyone in the pecking order — from phamaceutical companies and their sales agents, to the labs and purchasing agents, the doctors, the hospitals, HMO’s, PPO’s and now even the new “trend” of concierge medicine — and, of course, the insurance companies. They are all partners in crime, and the crime is directed against us — the people who need their services.

    I have had no income since 2000. I am paying $730 per month for an HMO membership which does not cover office visits, lab tests, hospitalization or DME. I borrow money every month to pay my medical bills, am quite ill, and over $100,000 in debt. Because I’m considered “high risk,” I cannot obtain any other insurance (at any price).

    How long will it take before something is done about the tragic condition of our medical system?

    Posted by Sharon |
  4. I have some of the same issues. I have a continuous glucose monitoring sensor. My insurance company pays NOTHING on it or the replacement sensors, which cost $350 for a box of ten. That box of 10 lasts 60 days. If it keeps me out of the hospital ONE time in a year, the insurance company comes out ahead. But they don’t want to hear it!

    Posted by Teresa |
  5. Calgary, oh yes, a pump is worth it. By following exactly what you describe with correcting highs and anticipating meals, but you have no syringe to pull out, no insulin to have to carry with you and keep cool, can be done discreetly no matter where you are. Most people think I am looking at my cell phone when I am entering data. It also keeps track of when you had that last bolus of insulin and how active it still is. Don’t know about you, but I am not that good at keeping up with that. As for night time, I have a belt with a pocket for the pump and I never notice it is there. I have used a pump for 10 years, and I LOVE it. I now also have added a CGMS. And since I just had to start peritoneal diaylsis for kidney failure, I also have that tube coming out of my belly! Believe me, the insulin pump that can be detached for intimate times, is no big deal.

    Posted by Teresa |
  6. Calgary, sweatpants are available with pockets for winter. You can order pajama bottoms with a pocket for your pump from a website called Diabetes Mall. They also carry t-shirts with pump pockets.
    You can get these items from many places on the Internet.
    I have been using my pump 4 years.
    It allows me flexibility that syringes
    DO NOT HAVE.
    Just call me: LUV MY PUMP! ! !

    Posted by ScottK |
  7. I went to hospital last year and had a partial left big toe amputation. I paid for my MRI privately at $900.00. This included dye and xrays of my foot and reading the scan and xrays. That was on friday. On saturday I was advised to check into hospital. On Sunday the hospital performed an MRI with dye and xrays as well. $7,200.00 for the MRI and Xrays and $500.00 for the reading of the xrays and MRI. A total of $7,700.00!!! This is $6,800.00 more than I paid privately!! Ihad no insurance and the 4 day hospital stay and medical cost $60,000.00!! The bill was reviewed in the light that I could not pay anything and was reduced to $15,000.00 by the hospital. Recently it was placed to debt collectors and they said that if I could come up with $11,000.00 they would accept it. So do you use insurance or pay it your self? Does the insurance company negoiate on all the expences and offer the hospital $15,000.00??
    Maybe they would also refuse to pay and save an additional $4,000.00 and settle with the debt collectors!!

    Posted by dazzaa9 |
  8. At last! Someone who udnrsetnads! Thanks for posting!

    Posted by Verle |

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