Are You Paying for Test Strips When You Don’t Have To?

News from the American Association of Diabetes Educators (AADE) annual convention in Washington, D.C., August 6 through 9, 2008. Marie McCarren attended “Monitoring Blood Glucose: To Test or Not to Test?” presented by Mary M. Austin, MA, RD, CDE, a certified diabetes educator and consultant in Shelby Township, Mich.

Test strips may be covered under your durable medical equipment benefit.

| Aug 21, 2008

Diabetes educator Mary M. Austin reported that many people are paying for blood glucose test strips even though their insurance plans would cover them. "There is a lot of misunderstanding," she said. For example, a client of Austin's got a free meter at a health fair. He then paid for strips on his own for six months, until he found out that his insurance plan would cover them if he got a prescription for the strips from his healthcare provider.

Austin also explained that insurance plans have two ways to cover test strips: through the pharmacy benefit and, surprisingly, through the durable medical equipment (DME) benefit. Because the DME benefit usually pays for expensive items such as wheelchairs and walkers, that "pocket" often has more money than the pharmacy pocket. "Go where the money is," said Austin.

If your pharmacy is not also recognized as a DME provider, they may tell you that your strips aren't covered. For example, nine months into the year, you may have reached the limit of your pharmacy benefit. The pharmacy may fail to mention that you may be able to get the strips through a durable medical equipment provider. 
Read your benefits package or call your member services to find out how strips are covered. Your plan may require you to use a mail-order company, or you may be able to go to a local business. Make sure your doctor's office has that information if they send in the prescription electronically.

Next: Use Them Well

Getting the test strips is only half the job. The other half is knowing how to use them.

Austin recalled a client who showed her his blood-stained logbook. He had faithfully checked his blood glucose four times a day for a year. All the results were over 200 mg/dl. He told Austin he didn't understand it. "My doctor told me that if I checked my blood sugar, it would improve," he told her.

Lesson: Blood glucose monitoring does not itself lead to lower blood glucose levels. You and your doctor need to do something with the data. But Austin says she often has this exchange with clients:

Austin: "Why do you check your blood glucose levels?"
Client: "Because my doctor told me to."
Austin: "Does your doctor look at your logbook?"
Client: "No."

If this sounds familiar, Austin has a suggestion: At your next appointment, take off your shoes and socks and stick your logbook between your toes. In other words, make sure your doctor looks at the data you have painstakingly collected. Ask your doctor: What are my goals for fasting and after meals? What can we change to get my blood glucose levels within goal?

Sometimes a logbook will show that most of the results are within goal, but the person's A1c is above goal. This can happen when, for example, the person checks fasting glucose every day but doesn't check at other times of the day.

Austin suggested a monitoring schedule that will give more useful information. One week check your blood glucose before and two hours after you start breakfast. The next week check before and after lunch, the next week check before and after dinner, and throw in a couple of bedtime checks as well. If you are allowed only 30 test strips a month, skip a day and then use the strips you saved to check before and after a meal the next day.

Over the course of a month, you will see what your blood glucose levels are at various times of the day. Then you and your doctor or diabetes educator will have a more complete picture upon which to base treatment decisions.

Marie McCarren is a medical writer who has specialized in diabetes for 15 years. Her books include ADA Guide to Insulin & Type 2 Diabetes and A Field Guide to Type 2 Diabetes.

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Posted by seashore on 21 August 2008

The AADE should issue general guidelines concerning healthy postmeal glucose readings. In Sept. 2007, the International Diabetes Federation (IDF) recommended that postmeal glucose 2 hours after beginning a meal should not exceed 140 mg/dl, because there is appreciable evidence that significant diabetic complications occur if this limit is frequently exceeded.

The postmeal glucose guidelines received by most diabetics are so confused and lax that they find blood glucose meters to be nearly useless in controlling their diabetes.

Posted by Anonymous on 22 August 2008

Is there a source for help getting strips if there is no insurance only medicare or medicaid?

Posted by mjensentulsa on 8 October 2008

"Because the DME benefit usually pays for expensive items such as wheelchairs and walkers, that 'pocket' often has more money than the pharmacy pocket. 'Go where the money is,' said Austin."

Actually, that DME "pocket" may require that you satisfy a deductible (hundreds or even thousands of dollars out of your own pocket), whereas the pharmacy pocket often requires only a copay (typically tens of dollars per month). Over the course of a year, one may be cheaper than the other. But in any case, it's generally one or the other, depending on your plan.

The advice that you should NOT necessarily take the pharmacist's "not covered" determination as final is good, though. They may not have tried submitting it as DME, or they may not be on the health plan's DME list, etc.

The best way to learn is to call the health plan itself and ask, "Are test strips covered under my prescription benefit or as Durable Medical Equipment?" and then, "Can I use any store/supplier or do you have a list of authorized stores/suppliers?"

(Another money-saver is to ask if they give a discount for bulk orders -- increasingly, plans will reduce your copay if you order three months' of supplies at a time.)

Also ask the health plan if they (the pharmacy/supplier) will need to have a prescription on file to submit the claim. If so, the next step is to get your doc to send a script to the place where you will buy the strips.

Finally, if, like the person in the story, you learn you have paid out-of-pocket for a covered benefit, ask if you can submit a patient claim for reimbursement. You are paying for the coverage -- you deserve the benefit!

And....SOMETIMES THE HEALTH PLAN WILL GIVE YOU THE WRONG ANSWER! If in doubt, try again until you get someone who is both helpful and informed.

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