Divemedic

I’m not defeated, and my last posts weren’t intended to convey that impression. Just because you are getting screwed doesn’t mean that you have to keep allowing it. I’m going to lose access to at least one doctor. My PCP has fired me from the practice, so I will have to get a new one. I am not sure yet about my endocrinologist.

I have been talking to some doctor friends, ones who work for my employer, and ones who do not. The doctors who DO work for my employer aren’t going to be able to write me a prescription for the more expensive drugs, and the insurance company says that I *have* to use the company’s pharmacy.

Usually, a provider or pharmacy that is not on the preferred list can still be used, albeit at a higher rate. They aren’t doing that here, and it’s being done that way to force patients onto the cheapest plan possible.

There are several loopholes in the system, and I plan on exploiting those. I will know within a month if I can make that work or not. All I know is that I am NOT going on insulin.

In my case, I need to get a doctor that will work with me, PLUS I need to get at least one refill on my medication under the current insurance, so that I have enough to last me until the open enrollment period for my wife’s insurance in July. I know plenty of doctors, but it’s the double hit of doctor PLUS pharmacy that is making it tough.

The rules and laws here are complex, but in complexity, there are loopholes. The more rules there are, the more holes there are to drive through. I have time to explore those, and even though I am screwed, I won’t be screwed forever. I don’t plan on staying that way.

Insurance companies hate diabetics even more than they hate smokers. The reason for this is that diabetics are famous for not complying with doctor instructions, and the disease is a progressive one. You don’t ever become cured of diabetes, the best you can do is manage or delay it. What manages it today will likely not manage it a year or two from now. It requires constant vigilance on the part of the patient and the providers. It’s a lot of work, and most of those who have it do not manage it well and wind up with complications like kidney, eye, heart, and brain problems. They wind up with nervous system problems, bone problems, and GI problems like gastroparesis. Treating all of this is expensive. The faster the patient dies, the cheaper all of that is from an insurance standpoint.

It isn’t that the insurance company is TRYING to kill you. No, they look at costs, and say “Gee, when we give drug X, diabetics cost us $y over their lifetime. When we give drug Z, they cost us $2y over their lifetime. Let’s only allow drug x.” They just don’t bother looking at anything else, it’s a pure monetary decision.

For those reasons, insurance companies WANT you to keep eating like shit and taking insulin, knowing that this will save them money over the long run. That’s why insurance companies want you to eat a regular diet and take cheap medicines like metformin. It’s up to each diabetic to carefully monitor their A1C, find trustworthy doctors who care about their patients, and keep on your insurance company’s ass. No one cares as much about you as you do.

Normal blogging to resume soon.

Shady stuff with my health insurance. The way that health insurance works with large employers is that the employer pays the bills, and the actual insurance company administers the entire thing. It’s cheaper for the employer that way.

I tried to get added to my wife’s insurance. It is outside of her open enrollment period, so I need a letter saying that I am no longer able to see my chosen doctor under my current insurance. No one will put it in writing- not the insurance company, nor my employer’s benefits team.

The insurance company says that the decision to force me to use certain doctors came from my employer’s benefits team. The benefits team says that it came from the insurance company. They both suggested that I go to the insurance benefits webpage and look up my doctor to see that he isn’t on the list. That isn’t good enough- to get coverage, I have to prove that my coverage changed. No one will give me that.

Even worse, even if I wanted to change doctors, it’s snowbird season. Few of the doctors in the area are accepting new patients. Of the ones who are, the next appointment is in June. I pointed out that I only have medications until mid April. I was told “well, you can always go to the emergency room. They can refill your medicine.” I can’t believe that it’s illegal to pay cash for a doctor visit if you have insurance and your insurance won’t pay for it, so your only choice is to start patronizing the emergency room.

No. The emergency room will only give insulin. That’s the point of this. I don’t want to be an insulin dependent diabetic. That is a death sentence, it’s only a matter of time at that point. I have done this for more than 30 years, and I know where that road ends.

I will have to deal with this on my next weekday off. It’s daunting.

I am a diabetic, and have been for two decades. I always knew that I would be, mostly because of my family medical history. My Father, his mother, and his father all had diabetes. It killed every one of them before they were 64 years old. I often joke that I lost the genetic lottery. My grandfather died when he was 47 years old. My grandmother, when she was 63- after having to live without legs for two years. My father died at 62. When I was diagnosed with diabetes, I lived in fear that I too would be dead before I could collect Social Security.

About 4 years ago, the diabetic medicines that I was on stopped being effective, and my A1C climbed to 10.0. This is a part of the disease- diabetes is a progressive disease. My doctor wanted to put me on Insulin, but knowing just how fragile diabetics become when they go on Insulin, I wanted other options. I see the story every day- insulin dependent diabetics inevitably go down the same road, ending in amputations, kidney failure, and death. Having to be on Insulin is a death sentence. I wasn’t going to do it.

That’s when the new class of diabetic medicines came along, and they were a miracle drug. Once I began taking Mounjaro, my A1C dropped to the mid 6’s, and my blood sugar is now well controlled. For the first time, I began thinking that I might actually make it to my 70’s. My last A1C was 6.2.

Since I could prove that I had been on Metformin and Actos for more than a decade, my insurance was willing to cover the $3,000 per month charge for the medicine. Insurance companies hate these new drugs- that’s why they got the Biden administration to go on a rampage to lower the cost of Insulin- they needed a cheaper alternative to the new medications.

Then two years ago, I got a new job. A new job means new insurance. The hospital that I work for, who is also my insurance company, requires you to get all of your medicine from the company’s pharmacy. That pharmacy has done everything that they can to force me to switch from the more expensive drug and take insulin. They delay filling my prescriptions, and say that they don’t have any, but if I would only switch to insulin, they have plenty of that available. I refused, and kept forcing them to pay for the drugs. As long as my doctor says that this drug is medically necessary, the insurance has to pay for it.

So this month, two months after the open enrollment period ended, my insurance company informed me that they will no longer pay for me to see any doctor who isn’t employed by the company that owns the hospital, and not coincidentally, the pharmacy. Not only that, but they are prohibiting me from paying out of pocket to see my current doctor. That was confirmed by my doctor this morning. They were threatened with legal action if they continued to see me for cash while I have active insurance. All of my future doctor’s appointments were cancelled. I offered to pay cash, and my doctor’s office told me that they can’t let me do that as long as I have active insurance. Now I am forced to see a company doctor, who will immediately place me on insulin.

I have a three month supply of medication left, and will be out of it by April 28. I can be added to my wife’s insurance during her open enrollment period, but that isn’t until July 1. It looks like they are going to force me to become Insulin dependent. I am sitting here thinking that my employer would rather kill me than pay for my medicine.

The only way to be added to my wife’s insurance earlier is to get a new job, and it has to be involuntary. I have to find a new job, then find a way to get fired, and I have to do it within the next three months. Maybe I can ask my boss to do me a favor and fire me.

My only other option is to try to convince a compounding pharmacy to sell me some generic, but you have to be obese for that to be legal, and I am not fat enough for that.

I am screwed.