Health benefits for diabetics...help!

Chnandler Bong · 01-04-2007, 03:56 AM

A member of my family was recently diagnosed with Type 1 diabetes. Four shots a day for the rest of his life. Apparently my health coverage has a huge gap when it comes to blood sugar testing supplies. Even though they were prescribed, they are not covered because they can be purchased over-the-counter. Aetna was nice enough to offer to pay for the monitor ($30) because they deem it medically necessary. However, they claim that they are not responsible for the testing strips, which the monitor is useless without. These strips are going to cost me over $300 a month.

I know I am not the only driver to have a family member with diabetes, so any help would be appreciated. Do I have to keep fighting with Aetna and appealing their denials? Or is there a program within UPS that helps close this gap? I am a membr of local 710, if that matters.

This has been a huge life change for us. The money problem only magnifies it. I can't imagine how people without insurance get by.

jules23 · 01-04-2007, 05:55 AM

I don't know if this will help at all, but I have diabetes also and have insurance with Aetna. As far as I know, Aetna only pays for the monitor - everything else is out of pocket. It's too late for this year, but for next year you can set aside money in a flexible spending account (FSA). It's tax free and you're allowed to cover diabetes medications, insulin, and supplies (test strips, etc.) through it. Do you have access to the Aetna website? If you are covered through them you can sign up online and all the information about what's covered through FSA.

Have the family member talk to their health care provider - if it's your child you talk to them. Sometime the doctor knows about state and federal programs that can offer payment assistance for supplies and medicine. It's worth a shot. The American Diabetes Association is also a good source of information.

Also, shop around...there are many online drugstores and places that sell strips - sometime cheaper than you get them in the pharmacy or store and they offer rebates, free shipping, etc. depending on how much you spend.

I hope this helps.

moreluck · 01-04-2007, 06:18 AM

Wilford Brimley (actor) does commercials about diabetic supplies from Liberty Medical. Maybe you could check them out too.

advisor1 · 01-04-2007, 07:45 AM

My wife has type 1 and her strips were covered. We are with Aetna and do the mail order through Medco. We pay 25% and Aetna pays 75%.
Also my wife has a insulin pump that Aetna paid about 80% of the cost.

helenofcalifornia · 01-04-2007, 09:18 AM

What's the difference between Type 1 and Type 2 diabetes? And what kind of diabetes is the one you can get if you get heavy?

moreluck · 01-04-2007, 11:21 AM

Type 1 diabetes (formerly called juvenile-onset or insulin-dependent diabetes), accounts for 5% to 10% of all people with diabetes.1 In type 1 diabetes, the body's immune system destroys the cells that release insulin, eventually eliminating insulin production from the body. Without insulin, cells cannot absorb sugar (glucose), which they need to produce energy.
Type 2 diabetes (formerly called mature-onset or non–insulin-dependent diabetes) can develop at any age, but most commonly becomes apparent during adulthood. However, the incidence of type 2 diabetes in children is rising. Type 2 diabetes accounts for the vast majority of people with diabetes—90% to 95%. In contrast to type 1 diabetes, insulin resistance is the main characteristic of type 2 diabetes. Insulin resistance refers to the body's inability to respond properly to insulin. Resistance develops because of many factors, including genetics, obesity, increasing age, and having high blood sugar for a long time.

woodenfoot · 01-04-2007, 05:31 PM

my strips are paid for 80 atna 20 myself being retired better yet i got on v a meds being a vet 8 dollars a 30 day supply atena pay 80 of that i am looking for a mail order for my wife s meds ron 710 chicago

derf3733 · 01-04-2007, 07:21 PM

Shop at Costco or Sam Club if you have one in your area. There prices will be the cheapest around and you don't have to be a member to use the pharmacy.
I know at Costco.com you can price any drug online.

01-04-2007, 09:57 PM

my daughter has type 1, and i had to have the doctor provide written notice to the central states that the test strips are necessary part of her care. make sure that they state she needs at least 3 strips extra a day in case, and the insurance will cover them.

Chnandler Bong · 01-05-2007, 08:08 PM

I just wanted to thank everyone for their help and provide an update on my problem. I've been spending my last few lunch hours on the phone with our various insurance companies and I think it has finally been straightened out. Aetna says they will pay for the strips and that everything I submitted to them was correct. Apparently there was some confusion on the part of the people processing my claim. They looked at it as an over-the-counter prescription and automatically denied it. However, the way I now understand it, these are included in our insurance under our "Major Medical" as "durable equipment and supplies". Regardless of who our prescription coverage is with.

I won't actually believe any of this until the check is in my hand, but it is good news for now. I sometimes wonder if it isn't policy for insurance companies to deny claims and put up as many roadblocks as possible in the hopes that people will just give up and pay out of their own pockets. As I previously stated, I don't know how people can get by without health insurance. And I am extremely grateful for ours. But ALWAYS question them!

By the way. I found a website that sells these supplies at wholesale rates. I haven't tried them, so I can't say if they are legit, but their prices are better than anything I can get locally. Since Aetna only pays 80%, it may be worth looking into. But they may not be any better than some of the places previously mentioned.Diabetes Testing Supplies - Discount Diabetic Supplies - American Diabetes Wholesale

Happy New Year and thanks again. Will repost if this falls through...

toonertoo · 01-05-2007, 09:05 PM

If Liberty Mutual cannot help go to www.phrma.com Coming Soon!, or to the drugmakers website. I had good luck getting meds through this site for my father. Not all of them go by income, some just by the need. It is a time consuming venture to get help with meds, but once I found the right area, I got help with most.

blue efficacy · 01-08-2007, 01:21 PM

I am a diabetic UPS employee. And I had no problems getting reimubursed for insulin, test strips or syringes. It was just like any other prescription medication. Although I am a part timer with UPS insurance, I am not looking forward to going full time and dealing with Central States insurance.

Chnandler Bong · 01-10-2007, 06:18 PM

Still having problems! The lady I talked to at Aetna assured me that this was taken care of and resubmitted my claim for me. I just got the results from the Aetna website. Now they say they will pay for it, but they will only pay 80% of $56 ($44.80) out of $275 worth of testing strips. Says that charges exceed plan limits. Are you friggin kidding me?!? I expected them to pay 80% of the total. Why am I having so much trouble with this!!!!!!!!!!!!

Fishcat · 01-12-2007, 08:20 AM

There are many companies that offer supplies for children for whatever your insurance will pay. My daughter was diagnosed at age 5, and my wife found AAA medical supply out of Florida. The only supplies we pay for are Keytone strips and alcohol pads. You could contact the Childrens Hospital in Little Rock Arkansas --they can help find affordable medical supplies.