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Insurance, Skin-Prep Wipes, and Principle (Part 1)
March 19, 2009
Seems that every month or two I have another blog entry about the runaround I’m put through in communications with my insurance provider, durable medical equipment supplier, or pharmacy. If you’ve wondered when the latest episode of A Boy and His Insurance Coverage would show up, fear not. This week it’s an exciting installment of "Four Weeks, Fifty Phone Calls: What I Did For A $17 Box of Skin-Prep Wipes" (Part 1 of 2!).
Before we get started, however, do realize that I know how fortunate I am to have my medical insurance benefits. I pay relatively little each month compared to the amount of money that I pull from my benefits (diabetes-related treatment for the most part, of course). All told, it’s pretty great coverage.
But just because I’m well-provided for does not mean there aren’t flaws for me to point out, to complain about, to blog about. It never fails, either, that the difficulties in getting an insurance problem ironed out are always wrapped up in the poor communication structure inherent in our bloated health-care bureaucracy (BHCB).
The trials and tribulations over my procurement of a box of skin-prep wipes begins over two months ago, and it pretty much unfolds, incrementally, with an hour or two of phone calls each week. There’ll be lots of backtracking, dead ends, and miscommunications. And remember, none of what you’re about to read will be resolved until this past Monday, which means that it wasn’t until yesterday that I finally received a box of protective barrier wipes (PBWs) in the mail.
As you know, a phone call within the BHCB can never be a quickie. A phone call to my insurance provider or durable medical equipment provider (DMEP) means that each time I call I have to run the gauntlet of automated menus and different service specialists, most of whom are unfamiliar with the previous phone calls made to their company. This means that I need to encapsulate as succinctly as possible (difficult to do, mind you) the reason that I’m calling. Then, after my synopsis, the representative (or whatever the title is of the person on the other end) inevitably says, “Hold on, let me transfer you to X, who can better help you.”
It’s quite difficult to find a pattern in how I’m jostled about in the BHCB phone system. Believe me, I try to preempt the runaround by asking for X from the get-go, but they’ll say, “How can we be of assistance to you today?” or “What’s the nature of your problem?” and once again I’m back to summarizing and repeating. Again. And again.
When my DMEP shipped my quarterly allotment diabetes supplies — infusion sets, insulin reservoirs, test strips, lancets, that kind of stuff — at the end of January, I was also expecting a 50-count box of Reliamed Protective Barrier Wipes. These wipes, as I understand it, help reduce “adhesive removal trauma” if I use them prior to affixing my insulin pump infusion set. The wipes also have it over the typical alcohol prep wipe in that they leave the skin slightly tacky upon drying, which helps the infusion-set adhesive get a better purchase. These PBWs
Either way, I’ve been using them since I started using the insulin pump two years ago. I’ve been getting them in my supplies shipments, and so I’ve grown used to them.
Prior to the end-of-January shipment, I had contacted my DMEP to ask what supplies were slated to ship. I knew I needed more PBWs, and I had some other questions about my supplies, those that I didn’t need to re-up at the moment. I can’t recall if I’ve blogged about this topic before, but I do have a fear that if I tell my DMEP that I don’t need more of X, I may get cut off down the road. I’ve since learned that hoarding equipment and supplies is better than being without because I’m trying to break even each month.
DMEP told me they’d ship more PBWs.
When the shipment arrived, there were no PBWs. The box of supplies that did ship? Everything else was there, all $2,500 of it for three months’ worth of accoutrement, completely covered by insurance.
The box of barrier wipes that failed to ship: about $17.
Let me repeat that: $17.
I call my DMEP and ask where the PBWs were. They said oh, sorry, those aren’t covered, that I’d have to contact my insurance provider to get more clarification because PBWs aren’t part of my DMEP’s contract with my insurance provider. Thus, if they ship them to me, they don’t get reimbursed for them.
Huh? But you’ve been sending them for almost two years. Nothing’s changed. Why stop now?
Really, I could have just given up at this point and gone down to Walgreen’s and bought a box, which would last me about a year. Or could I have? I don’t think I need a prescription to purchase PBWs, but I’m not sure. The point is — the principle of the whole issue, and why I’m writing this in the first place, is — that my insurance covered PBWs before, shipped PBWs before, for nearly two years. If my insurance company tells me they’re covered, I thought it means they’re covered. Right? Why should I pick up the tab if I don’t have to?
I just don’t understand much, I guess. And the fun really begins there.
To be continued next week…
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