Diabetics - insurance covered blood ketone testing!
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RalfLott
Posts: 5,036 Member
Very quietly, my insurance co (BCBS) started covering diabetes monitoring and education expenses. This appears to be a "you have to ask" scenario, as nowhere in my skimpy plan documents is there mention of such benefits.
After many rounds of correspondence with my endocrinologist's office and BCBS, it finally stated, in writing, that it would cover prescribed Precision Xtra blood ketone test strips without limitation and with no co-pay for both Type 1 and Type 2 diabetics.
Due to low reimbursement rates, it took weeks of hunting to find a pharmacy willing and able to supply the meter and strips.
As a T2D, I'm now covered for the following monthly benefits (pending announced but unspecified reductions in coverage starting in January 2017
..... ):
100 blood ketone test strips
300 blood glucose test strips
1 dietitian visit
1 blood ketone/glucose test meter (annual)
@baconslave
After many rounds of correspondence with my endocrinologist's office and BCBS, it finally stated, in writing, that it would cover prescribed Precision Xtra blood ketone test strips without limitation and with no co-pay for both Type 1 and Type 2 diabetics.
Due to low reimbursement rates, it took weeks of hunting to find a pharmacy willing and able to supply the meter and strips.
As a T2D, I'm now covered for the following monthly benefits (pending announced but unspecified reductions in coverage starting in January 2017
..... ):100 blood ketone test strips
300 blood glucose test strips
1 dietitian visit
1 blood ketone/glucose test meter (annual)
@baconslave
6
Replies
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Wow! That's awesome!
My daughters doctor wouldn't even prescribe the blood ketone strips because she said insurance never covers them and she of course thought they were unnecessary since as a T1D they just want no ketones at all and so the negative urine test is sufficient.
I doubt my insurance would cover them though since I had to appeal just to get the strips that go with her pump meter and to get the brand of insulin that works best for her.
But that's great that you'll get to collect all that data for yourself going forward.1 -
Sunny_Bunny_ wrote: »Wow! That's awesome!
My daughters doctor wouldn't even prescribe the blood ketone strips because she said insurance never covers them and she of course thought they were unnecessary since as a T1D they just want no ketones at all and so the negative urine test is sufficient.
I doubt my insurance would cover them though since I had to appeal just to get the strips that go with her pump meter and to get the brand of insulin that works best for her.
But that's great that you'll get to collect all that data for yourself going forward.
Thx. I'm cautiously optimistic but not going to dig in until I find out if the coverage will continue.. (But I did land my first 100 covered strips, so I'm happy.)
I don't understand why ketone strips wouldn't be covered for your T1D daughter. Makes no sense at all, but, fortunately, she had you in her corner!
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Sunny_Bunny_ wrote: »Wow! That's awesome!
My daughters doctor wouldn't even prescribe the blood ketone strips because she said insurance never covers them and she of course thought they were unnecessary since as a T1D they just want no ketones at all and so the negative urine test is sufficient.
I doubt my insurance would cover them though since I had to appeal just to get the strips that go with her pump meter and to get the brand of insulin that works best for her.
But that's great that you'll get to collect all that data for yourself going forward.
Thx. I'm cautiously optimistic but not going to dig in until I find out if the coverage will continue.. (But I did land my first 100 covered strips, so I'm happy.)
I don't understand why ketone strips wouldn't be covered for your T1D daughter. Makes no sense at all, but, fortunately, she had you in her corner!
I never got the ketone strips. The doctor wouldn't even write the rx...
But I did fight for blood glucose strips and insulin for a T1D! Lol. Ok. Not really funny.
I mean, I guess they did cover them, just not the ones she was compatible with... had to fight for those.1 -
Considering that there are charities who do nothing more than train service dogs to detect ketone problems in T1Ds, you'd think it would be a gimme.0
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I was able to get a prescription as a Type 1, but my insurance will only cover 10 blood ketone strips per month. So I almost never test. If I ever was in DKA, I guess they just would prefer I go to the hospital sooner rather than handle it at home. There is a point where it gets too far along to be able to handle on my own. And at that point, a hospital's equipment and lab comes in handy more than the ER docs and nurses. But if I'm not so bad that I need those labs (for example, BG is too high for home testing equipment and electrolytes need monitoring), then wouldn't it make sense to let me keep home testing ketones until either I'm not in DKA anymore or it has gotten too bad to home treat?! Or what if I'm just sick with the flu or something for a long time... testing ketones as a precautionary measure?2
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Wow, that's incredible! My insurance covers the glucose strips in abundance, but not the ketone test strips. Not even if I were T1.
I was lucky enough to get in on a FREE (yes, giveaway) meter deal that Precision had going on - so I got my Precision Neo for free - mailed to me in about a week. I pay for the ketone test strips - but I don't mind considering I don't test ketones that much.1 -
Our insurance is through CVS/Caremark. They have allowed 600 glucose strips for three months. 6 times a day x 30 days x 3 months, rounded up. The cost in 2016 was $75.00 That is now. Next year, I just don't know since our plan is changing. I have no info on the cost of Blood Ketone Strips since they were never offered.
Next year our insurance is a new type called a Health Savings Account, we have to pay prescriptions, medical procedures and doctors until our high deductible is met. After that we pay a 25% copay. Theoretically, CVS will have an agreed upon cost for us that will be lower than their list as well as a contractual price of medical procedures and doctors visits. I don't think we can afford as many glucose strips under this new plan, let alone blood ketone strips. The unknown is definitely scary.
I have tried to ask for prices from CVS for next year, but have met a wall, they said they had to process the prescription before telling me what my prices are. CVS list price here in Metro Atlanta is $86.00 for Metformin, as of a few months ago. I think I will go to Publix for my Metformin (free) and Sams Warehouse for the others if their contractual prices are unreasonable.
One of the changes that Obama Care has brought is that A1C is included in your wellness checkup. So I will take advantage of that and skip one of my diabetes appointments. Perhaps the coverage of blood ketone strips was part of that deal as well. Chest xRay and EKG was taken away. Our Overlords giveth and taketh.
Happy Holidays everyone!1 -
Our insurance is through CVS/Caremark. They have allowed 600 glucose strips for three months. 6 times a day x 30 days x 3 months, rounded up. The cost in 2016 was $75.00 That is now. Next year, I just don't know since our plan is changing. I have no info on the cost of Blood Ketone Strips since they were never offered.
Next year our insurance is a new type called a Health Savings Account, we have to pay prescriptions, medical procedures and doctors until our high deductible is met. After that we pay a 25% copay. Theoretically, CVS will have an agreed upon cost for us that will be lower than their list as well as a contractual price of medical procedures and doctors visits. I don't think we can afford as many glucose strips under this new plan, let alone blood ketone strips. The unknown is definitely scary.
I have tried to ask for prices from CVS for next year, but have met a wall, they said they had to process the prescription before telling me what my prices are. CVS list price here in Metro Atlanta is $86.00 for Metformin, as of a few months ago. I think I will go to Publix for my Metformin (free) and Sams Warehouse for the others if their contractual prices are unreasonable.
One of the changes that Obama Care has brought is that A1C is included in your wellness checkup. So I will take advantage of that and skip one of my diabetes appointments. Perhaps the coverage of blood ketone strips was part of that deal as well. Chest xRay and EKG was taken away. Our Overlords giveth and taketh.
Happy Holidays everyone!
Those high deductible plans are terrible for those of us with chronic diseases. And HSA's are very similar to FSA's to cover out-of pocket costs (read: self-pay) with high deductible plans. Sounds like your employer switched plans to save themselves some money and offset that cost to you. I hope that comes with a wage increase to make up at least part of the difference (though I'm sure it doesn't).0 -
A wage increase?!!!! Maniacal laughter is taking place in our house right now. My husband is turning 65 at the end of this year. He will be continuing to work until he is 69 due to the Great Recession and frozen wages. We just received notice that his pension payments are being suspended while he is still working and they will NOT be paying him back later for those missing payments and no actuarial increases. Loophole in the federal pension laws. Oh, and they dropped retirement health benefits earlier this year. So the people who retired early and their families are forced onto the exchanges and more out of pocket.0
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No point worrying - we're powerless to do much about it.
But we can be thankful that, through whatever detour each of us took around the ADA, we found a path toward giving us much greater control over our malady than most diabetics had any clue about in the past (especially back before the first edition of Dr. Bernstein's book).0 -
midwesterner85 wrote: »Our insurance is through CVS/Caremark. They have allowed 600 glucose strips for three months. 6 times a day x 30 days x 3 months, rounded up. The cost in 2016 was $75.00 That is now. Next year, I just don't know since our plan is changing. I have no info on the cost of Blood Ketone Strips since they were never offered.
Next year our insurance is a new type called a Health Savings Account, we have to pay prescriptions, medical procedures and doctors until our high deductible is met. After that we pay a 25% copay. Theoretically, CVS will have an agreed upon cost for us that will be lower than their list as well as a contractual price of medical procedures and doctors visits. I don't think we can afford as many glucose strips under this new plan, let alone blood ketone strips. The unknown is definitely scary.
I have tried to ask for prices from CVS for next year, but have met a wall, they said they had to process the prescription before telling me what my prices are. CVS list price here in Metro Atlanta is $86.00 for Metformin, as of a few months ago. I think I will go to Publix for my Metformin (free) and Sams Warehouse for the others if their contractual prices are unreasonable.
One of the changes that Obama Care has brought is that A1C is included in your wellness checkup. So I will take advantage of that and skip one of my diabetes appointments. Perhaps the coverage of blood ketone strips was part of that deal as well. Chest xRay and EKG was taken away. Our Overlords giveth and taketh.
Happy Holidays everyone!
Those high deductible plans are terrible for those of us with chronic diseases. And HSA's are very similar to FSA's to cover out-of pocket costs (read: self-pay) with high deductible plans. Sounds like your employer switched plans to save themselves some money and offset that cost to you. I hope that comes with a wage increase to make up at least part of the difference (though I'm sure it doesn't).
I would disagree about the HSA plans with high deductibles not being good. That is what I have and, just putting away my savings in premiums plus what I would typically pay in co-pays and such (using previous years average), I had enough to cover everything this year and have a little left over that will roll over into next year. I am now about to head into my 3rd year using this. This was the year I thought would be the most challenging because we had heavy medical expenses up front. Turns out we hit our deductible before mid-year. For the last few months, my wife's meds have cost us nothing out of pocket.
I am sure there are HSA plans with high deductibles that are not as good. The key is making sure you know what you have and putting the right amount of money into the savings plan part. It isn't like an FSA where it is use it or lose it. It will roll over year after year earning interest.0 -
A wage increase?!!!! Maniacal laughter is taking place in our house right now. My husband is turning 65 at the end of this year. He will be continuing to work until he is 69 due to the Great Recession and frozen wages. We just received notice that his pension payments are being suspended while he is still working and they will NOT be paying him back later for those missing payments and no actuarial increases. Loophole in the federal pension laws. Oh, and they dropped retirement health benefits earlier this year. So the people who retired early and their families are forced onto the exchanges and more out of pocket.
I didn't figure that would really happen. By cutting health care benefits with this switch to a high deductible plan, the effect is a decrease in compensation. Notice how companies can always afford to pay top executives very well even when they say they have to cut pay for normal employees?! Anyway... that starts to get off topic.
The only thing I can suggest is looking at stores where the products are known to be cheaper or using the Google Shopping search feature to find the lowest price online.0 -
One must have extra money to put into the HSA and depending on circumstances, one may emerge a winner on this plan or a looser. Typically young, healthy, high wage earners benefit from this plan. One also may simply avoid seeing a doctor. That is my plan since I do not want to spend my retirement money on doctors before I retire. This diet has normalized my sugars but I still need to check them and take metformin. Silly liver makes excess glucose. God help those with serious health issues or accidents.0
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One must have extra money to put into the HSA and depending on circumstances, one may emerge a winner on this plan or a looser. Typically young, healthy, high wage earners benefit from this plan. One also may simply avoid seeing a doctor. That is my plan since I do not want to spend my retirement money on doctors before I retire. This diet has normalized my sugars but I still need to check them and take metformin. Silly liver makes excess glucose.
Yes, those are the people for which high-deductible plans were made. The self-pay part and HSA's are just a way for employers to make you pay a substantial part of your own health care costs. If they had a good plan covering most of those costs for you, and then switch to a high-deductible plan with HSA (self-pay), then that is a decrease in compensation.
I'm glad you are improving your health, though, so you can at least mitigate some of those increased out-of-pocket costs.0 -
One must have extra money to put into the HSA and depending on circumstances, one may emerge a winner on this plan or a looser. Typically young, healthy, high wage earners benefit from this plan. One also may simply avoid seeing a doctor. That is my plan since I do not want to spend my retirement money on doctors before I retire. This diet has normalized my sugars but I still need to check them and take metformin. Silly liver makes excess glucose. God help those with serious health issues or accidents.
Pardon the brief hijack. I'm not diabetic, but I have this very problem. (i.e. deductible and HSA) My hubby's employer offers us one option: over $400/mo in premiums plus a $7000 deductible before it pays one cent with the exception of 1 check-up per member per year. So we avoid going to the doctor. The kids get their check-up and shots. I take mine, but any bloodwork needed is not covered. Last time, that was $1000 out of pocket. After that burn, I did not schedule a follow up, even though the bloodwork did not find anything when it should. I couldn't afford it. I have symptoms of Sjogren's Syndrome, which I think are actually caused by something else like a severe hormone imbalance. But I can't do anything about it. Get sick during the year and need a visit to the Dr or need a prescrip, deductible strikes. We burned through our HSA savings of $5000 paying for vision therapy for my youngest daughter. None of the therapy would be covered until the deductible was met, but it wouldn't count toward the deductible either! What a screw over! Now my youngest son needs it. Too bad, right? I'm paying for braces for my 14-year-old every month. Out of pocket of course, because dental insurance won't cover it. *insert extreme eyeroll* I'm hoping that I can find a local org like the Lions Club to help fund my son's eye therapy in the new year. I'm doing patching and some other exercises they used with my daughter on my own to see if I can get him to improve. I don't get paid to do NeuroRehabilitation Therapy. And I'm homeschooling 4 kids. Talk about overtime...
We're 1 emergency room visit away from a $7000 hit. Every year. $12,000 a year OOP for medical bills (premium + deductible not including dental and vision insurance. That's more) is a bit much to expect for anyone. Well, it's been a year, let me tell you. And thanks to our crappy insurance, we paid that out last year and didn't even meet the deductible thanks to the therapy. That doesn't count the braces. We also had to buy and remodel a house for my father to live in...Thank the Lord for our frugality in the past that allows us to have good credit.
If hubby's company screws up (possible) and loses his contract and is unable to get him another, we are in big trouble after 12 months. We have just enough savings to cover that amount of time.
I'm certain that my brother-in-law who is newly married and has no children enjoys his HSA/deductible plan. Companies seem to penalize employees with children. Times have certainly changed. When my husband was hired 10 years ago, we had to pay just over $200/mo with modest co-pays and no deductible...
Medical pricing is out of control.
ETA: Urmmm...that wasn't brief. Sorry.
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*kitten*
Makes me glad that since I retired, my premium, deductible, and co-pays have merely doubled (may be trebled come Jan. 1, though..).0
