A request: Once you are done reading today I’d like you to share one of two things: an insurance fight you’ve won or lost, or: how and when you transitioned to handling your own insurance battles. Thanks!
My young-adult daughter’s endo had just suggested she enroll in a one-week diabetes “refresher course” late this summer. Said daughter was calling it “diabetes rehab” and crooning about it ala Amy Winehouse (“They told me to go to diabetes rehab and I said: ohhhhhh, ohhhhhh, lowwwwws!”). I, on the other hand, was on the phone with insurance. Fighting and explaining. Again.
And it got me thinking: Exactly how many hours do we folks in this Type 1 world spend on the phone going over and over and over things that seemingly should just be covered already? And if I took all the hours I’ve spent on insurance phone calls over the past 14 years and applied them to some sort of other effort, what could I be? An Olympic gymnast, maybe. The single-handed constructor of all the huts they need in Honduras. Or better yet: not stressed out. And: when exactly do I transfer this complicated effort over to my child? Because right now it seems like there is no way she can handle all this on her own.
In this case, I called our insurance company and explained the program and the reason my daughter’s endo felt strongly it was time for her to take part in something like this. And this is what I got for an answer: We don’t cover any diabetes educational costs other than at diagnosis.
Say what? Type 1 diabetes is a fluid disease. By that I don’t mean it changes every few years: it changes with the tides, and sometimes more often. Battling Type 1 involves a certain kind of prowess you might find in, say, fencing. You bob, you weave, you come up with a tricky attack plan and somehow, diabetes puts you on the ropes again and again. So the idea of only educating a person at diagnosis seems beyond nuts to me. And the idea of re-educating a person at different stages of their lives seems to just make sense. Heck, aren’t we supposed to be moving toward preventative health in our nation?
The woman on the phone was nice enough, but explained my argument could go nowhere. It was the policy chosen by the huge employer my family got insurance through. I hung up the phone frustrated.
And then decided to shoot the moon. I dropped an email to the Human Resource Director, who in fairness has tens of thousands of employees to worry about. I explained my issue briefly and asked for some phone time. She called me right away.
I was patient with my attack. I did my basic “What is Type 1 diabetes; how is it different than Type 2 diabetes and why it requires the constant attention it does.” Then I went into the specifics of this point of my daughter’s life (14 years with Type 1; a completely changed body since childhood; a new medical team as a young adult and the beginning to stepping into her own life with diabetes) and why some education would be good now. I pointed out other times it might be as well: when deciding to have children. After having children. Shifting into the middle of life. And so on. I think I said something like, “Trust me, this is not something we are trying to get because it’s ‘cool.’ If you think my daughter wants to spend a week of her summer inside a hospital getting educated about diabetes, you are wrong. Nothing fun about this at all. Trust me.”
I finished my plea and took a deep breath; expecting to be on those ropes again and getting my mind ready to come up with some tricky foot work (make that wordswork). And a funny thing happened:
The HR Director agreed. “You know,” she said, “I really appreciate you explaining this to me. It just makes sense. We are all about healthy living and to me, this kind of education seems like something we absolutely should cover. I’m going to put in a policy change. In the meantime, if you have any trouble with coverage, let me know and I’ll make sure this is covered for your daughter until that policy change goes through.”
Wow. I called my husband immediately with the good news. He said, “Looks like you won this time! Wait . . . have you ever lost?”
And I may not have, but that’s beside the point. This kind of fighting is ridiculous and wrong, even if I did come out on top. Whenever I have to take on these things (like the time she was little and the insurance company was trying to tell me we need less infusion sites. I won over with this line: “Honey, trust me: we are not putting these in birthday party loot bags!”) it takes up my time and energy and it chips away at my heart. I have to think each time: what about the people who are not able to fight, for whatever reason. Do they just go without the basics they need to not just thrive but simply get by with diabetes? And again: when will my daughter do this on her own? How will she do it on her own?
I’m not one for socialized medicine. But what would life be like if some of the needs of people with Type 1 diabetes was better understood by employers and insurers? How much less would the cost of diabetes on society be if everyone with Type 1 got all the coverage they need – be it for infusion sites, education, enough test strips or a variety of insulins? (And how about covering not just insulin pens but the needles that go on top to get the insulin out and into your body? I’m still scratching my head at that one). How much happier and less stressed would people with Type 1 and the people who love and care for them be if coverage was simpler? I’m guessing there are some mental health savings there as well.
I know it’s a lot to expect. But imagine if we all had, going forward, all that time to do something else instead? Quite possibly, we could save the world.
Here’s hoping for it.
A request: Today I’d like you to share one of two things: an insurance fight you’ve won or lost, or: how and when you transitioned to handling your own insurance battles. Thanks!
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