Playing God

Katherine Marple

| Aug 25, 2012

Recently, while scrolling through discussions posted on an online diabetes forum, I came across one from a man in his thirties who wrote about how paramedics had found his twin brother face down in a sauna, in an insulin shock coma.  How did he end up in such a state?  The appalling answer is, he didn't have enough glucose strips to test before he got into the hot tub.  A few weeks before the sauna incident, his insurance company had limited his glucose strips to just four per day.

For anyone with insulin-dependent diabetes, that is just asking for trouble.  Testing at meals alone (breakfast, lunch, dinner, and the recommended bedtime snack) would eat up his entire allotment.   What about the days when, no matter what you do, your glucose levels just aren't cooperating?  You're also supposed to test before you drive, before you exercise, after you exercise, and even more often when you're sick.  I personally test about ten times per day, even at 3 a.m. These tests are necessary in order to achieve the beautiful A1C results that doctors and insurance companies are always touting.

So why do insurance companies play God by limiting our supplies?  If we're not testing, our odds of going into shock or ketoacidosis are much higher, and the cost of keeping us in an intensive care unit to recover is more expensive than a few more strips per day.

A few years ago, my former insurance company put a limit on my diabetes supplies.  There is nothing quite like the terror that you feel as you watch your medication supply dwindling down to nothing, and you know that you've got a full week to go before your insurance will authorize a refill.  We need these things to survive, so it's more than horror-movie scary: It's a real life fear of imminent death.  You stand paralyzed, watching the Grim Reaper slowly drag his scythe up the road toward you.  Every month you watch him coming, and it's on your last breath, when he's staring you right in the face, that you dodge him and buy yourself one more month--just to do it again the next month.

I'm in a better place with a larger insurance company these days, but I will never forget that fear.  Insurance companies should not have that power.  No one should have the authority to put our lives on the line.  That control belongs to each one of us, and us alone. So, I have a message for the insurance companies. Please take a moment to chew on this:  You can't make money off of a dead person.

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Categories: A1C, Diabetes, Diabetes Health, Diabetes Health Magazine, Diabetic, Insulin, Insulin-Dependent, Ketoacidosis

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Posted by Anonymous on 26 August 2012

Oh my god that is scary that the insurance company controls the amount of test strips etc you are allocated. In New Zealand we are given the amount we need and extra we are so lucky, I really feel for you :(. I hope things get better soon.

Posted by Anonymous on 26 August 2012

Obamacare will limit us, with so many unemployed it's going to be bad. I live day to day as is and my a1c is horrendous because I must do so. Insurance companies should have taken a hit, as should the pharmaceutical companies, not us. Since the 90s, insulin prices have skyrocketed, especially once animal insulins were taken off the market. Humalog in 2000 was $35 a bottle, now it's $135, with a discount card - more than a 100% increase, even considering inflation, ridiculous!

Posted by Anonymous on 28 August 2012

I , too, test approximately 10 times per day since I am on an insulin pump, travel to various cities for work, stay in hotels alone, drive a car and excercise daily.
My insurance company has not only limited my test strips to 6.7 strips per day but told me I can only use one type of meter in order to receive strips with no cost under my plan. The type of meter I use directly reads into my insulin pump the results, key for me since I have vision problems.
Please let me know what the 0.7 strip looks like and how it will function over a full strip! Do you think you could have made it 7 strips a day?
The ridiculous nature of insurance companies playing God has gone too far. Follow the money. But my insurance company is happy to send me colorized, slick and glossies about managing my A1C and testing my blood sugar to optimal control. By testing 10 times a day I have maintained an A1C in the 6.8-7.1 range. Perhaps they would be happy to pay for a hospitalization when I have hypoglycemia or ketoacidosis instead, not to mention any additional complications long term.

Posted by Anonymous on 28 August 2012

As a diabetes educator and pump trainer for 20+ years, I have seen this problem with my clients every day. It is appalling that a physician can prescribe the amount of test strips, insulin, and supplies a person needs for managing diabetes, but the insurance company decides to override the order. Playing God or playing Doctor, either one is wrong! When the VA decided a few years ago to allow people ONE test strip/week if on oral medication, ONE strip/DAY if on insulin, we voiced our concerns, and there were changes made. I do not see people testing blood sugars for "the fun of it" or selling supplies for profit - what are the insurance companies afraid of?

Posted by Anonymous on 28 August 2012

I hate our healthcare and insurance system in the US. To me, it's borderline immoral. But, how do we change it? Those who don't think it needs to be changed, or are not in favor of universal healthcare have obviously never had to depend upon it.

Posted by rosiolady on 28 August 2012

"You can't make money off a dead person!" That is such a perfect statement! Indeed, why don't insurance companies think of this? It is because they are a large corporations and large corporations don't think beyond the end of their nose and routinely kill the golden goose. They are all about immediate profits. This is our current health care system, and nothing will change until our health care system is radically changed, in my opinion.

Posted by Anonymous on 28 August 2012

Wow! So true. How dare these insurance companies dictate our fate. Well done and said!

Posted by Anonymous on 28 August 2012

The problem with insurance companies is that they are only looking at the bottom line. Generally dibetics are expensive to insure so they at everything and require huge documentation to change anything. If people think that private insurers are the answer to our health care problems they probbly never had to get the treatment necessary to survive. At least with everyone on an insurance program the costs should be lower but don't bet on it. For those who don't have insurance or the insurance benefits are limited you can buy strips on eBay at a discounted price so there is no reason not to have the necessry strips to test when needed. I had to do that. Expensive maybe, but so is a hospital.

Posted by Anonymous on 28 August 2012

I work for a tribal health organization in Alaska, and we just switched from a self-insurance program for employee health insurance to the Federal Employee Health Benefits program, where I now need to deal with co-pays. I am Type 2, and not on insulin. But I still need to test my glucose a couple of times a day (especially since Sunday I ranged from a 45 to a 181, a rare fluctuation in glucose levels for me). Luckily, I was able to feel my glucose dropping (while I was napping), and woke up in time to test, drink a bunch of fruit juice and eat a bunch of fruit and chocolate to get my levels back up. But I almost didn't have enough strips to continue testing to make sure my glucose levels had stabilized. I need to order more strips, but the last time I did I was told I wasn't using the right brand of glucometer (I use the glucometer provided to all VA and IHS patients, and my insurance is for federal employees so you'd think they'd have this glucometer on the preferred list). That means it now costs me about $100 every three months in my co-pay to use the same test strips and glucometer I've been using for the past year. I live in a remote island community, so it's difficult to get the insurance company's preferred glucometer and test strips, but the company still insists I make the change.

Posted by Anonymous on 28 August 2012

I love that line: "You can't make money off a dead person". I've been saying for a long time that my insurance company would like to see me dead so they don't have to pay for my diabetes stuff (I'm type 1). Health Insurance is expensive. You would think we'd get good service and coverage. I guess we have to get used to it. Like most of you folks, I don't test as much as I should. There are times I've even starved myself so I don't have to use insulin. And yes, the paramedics ended up in my living room and I ended up in the Emergency Room. I guess that's what the Health Insurance companies want. Have a nice day everyone!

Posted by Anonymous on 28 August 2012

I have had a Continuous Glucose Monitor and Sensor for several years now and I must say the Sensor has saved my life. Just the other night, around 2 am my insulin pump started beeping and vibrating. Woke me out of a sound sleep. The pump indicated that my blood glucose level was 41. When I was able get up and take a finger stick, blood sugar was 37. I was able to get myself up and eat a granola bar I had on my nightstand. If not for this Sensor, who knows where I would be in the morning. Probably, unconscious and in an ambulance enroute to the hospital. I will be going on Medicare next month. Medicare does not cover Sensors, therefore, supplement insurance won't cover them either. With all the waste going on in Washington, why can't the Diabetics of this country get more help. We need it.

Posted by jdrusk on 28 August 2012

Insurance companies are penny wise and pound foolish. Always has been; always will be. I just hope one of the big insurers has a person moitoring Diabetes Health. They might learn something.

Posted by Anonymous on 28 August 2012

Prior to our present economic recession, I usually had a working relationship with my physical health insurance company. Following the housing market collapse around 2006, it seems that the national economic "money pie" has shrunk. More people are competing for the same dollar bill. This includes health insurance companies in that they are having to do with less money(as we are all). I have considered blogging about how my health insurance company has progressively spent less money on patients while requiring higher and higher premiums. I am 60+ yrs old and have DM T2 and insulin dependent. At times, I have felt my insurance company denied benefit coverage for my diabetic supplies as I was not T1. At one time, I was using the pump. I had to quit as I was unable to get coverage for pump supplies (per doctor's orders). This left me feeling bitter and angry. I feel that health insurance companies today blame us patients for their economic woes. In sum, I pay much, much more out of pocket for my health care needs than I did 15 yrs ago. For me, the future picture for health insurance coverage is grim.

Posted by Anonymous on 28 August 2012

After being a diabetic for 50+ years I have always thought test strips are priced too high. Searching for alternatives, I have recently changed to a Reli On Prime Meter and Prime Test Strips available at Wal Mart. The meter sell for about $17.00 and the strips sell for $9.00/ 50 strips. I have used them for a month and have found them to be accurate. At $9.00/ box the Test Strips are lower than my copayment for insurance. I would rather buy these than put them on my insurance as I also have a insulin pump and CGM.

By the way, I do not work for Wal Mart or the meter company.

Posted by Anonymous on 28 August 2012

Insurance companies have absolutely NO interest in our health - they are for-profit and that is all they are interested in. I have had type 1 for 56 years. Even though my husband and I worked all our lives, we have no retirement due to heavy medical bills (even WITH expensive insurance) - he is type 2 and we have a disabled daughter. I was even once told by an insurance company that I could only have 1 vial of INSULIN a month! I fought and won that one, but I shouldn't have had to fight at all. Frankly, I have better coverage now under Medicare than I ever did with private insurance. Insurance companies only want to cover healthy people.

Posted by Anonymous on 28 August 2012

Walmart has just unveiled their Relion Prime meter. Costs about $16 dollars. Takes 0.5 microliters of blood. holds 250 tests in memory. The strips cost $9 for 50 with free shipping if you live in a rural area. Cheaper than many insurance co-pays for other brands of strips. Also look at buying the Embrace meter and strips from! TrueResult/ is a pretty reliable meter that has fairly cheap strips that are widely available. I have a patient that buys TrueTest strips (for TrueResult and TrueToGo meters) off ebay. He says you just have to watch the expiration date. Please get the word out that there are options for people w/o insurance or with lousy insurance. As the author points out it is a life and death issue for those of us on insulin. Thanks for the article. Many good points!

Posted by Anonymous on 29 August 2012

Please don't "Fox-speak" blaming Obamacare without telling us specifically what is wrong with it. I think if you and I went through each of the provisions you would like or at least grudgingly accept most of the them.

Mr. Romney is forever pretty short on details of what his administration would replace it with and his pledged first act in office to repeal it. Since our do-nothing Congress cannot agree on which anything except to vote for new names of post offices, I doubt that is going even get to him since even if the Republican win the US Senate, the Democrats will do the same thing Mitch McConnell's minority in the senate has done - stop nearly all Congress business.

Think about this - Without Obamacare people with preexisting conditions like diabetes would still be refused insurance coverage. If anything, a single payer system like Canada and the UK would save far more money.

I very much agree with the comment about insulin prices. It is sheer price gouging. As well, I think there was a concerted effort by Lilly to kill off the animal-based production of insulin so the big insulin makers would exert a strangle hold on the insulin production industry, along with keeping generics and imported animal-based insulin out of the US market.

Posted by Anonymous on 29 August 2012

Although I am not terrible keen on Wal-Mart. I have to give them kudos. They really do have very low cost meters and strips under their own brand. The cost are sometimes less than the co-pay for more expensive strips.

Posted by Anonymous on 29 August 2012

Dealing with a life threatening disease is difficult enough without being threatened by not having the proper supplies to help control Type 1 Diabetes. A few years ago, I went on Medicare and got quite a shock when the said they would provide 1, yes 1, blood glucose test strip per day. They treat "all" diabetes the same. It took me months to convince them that I was required to test quite often because I am on an insulin pump. They greatly limit supplies and since my husband is still working, I found it necessary to go off Medicare and back on his insurance because I could not afford to continue to buy the supplies I needed. The problem here is that most Type 1 diabetics do not live long enough to go on Medicare so a one size fits all is their policy. This is an issue that needs to be addressed. M.M.G.

Posted by on 29 August 2012

As a Type 1 diabetic and a pump user, I must test, on average, about 10 times a day. I change my site every 2 days because going into a third day causes my BG to go out of control. When I went on Medicare, I found that I was allowed only "1" strip a day and a change of sites every 3 days. Explaining that I was a Type 1 diabetic and what my requirements were fell on deaf ears. Doctors perscriptions, downloading months of readings from my pump and glucose meter made no difference. After 3 months of frustrating calls and purchasing what I needed to stay alive, I went back on my husband's insurance as it was cheaper than staying on Medicare and a supplimental insurance. Unfortunately, if Medicare denies something, so does the supplimental insurance. I surmised that there are few Type 1 diabetics who live long enough to go on Medicare and Medicare is ill informed about the disease. This is a serious issue that needs to be addressed.

Posted by Anonymous on 29 August 2012

All of the above make good points. I agree about doctors or providers mandating usage as four strips per day for Type 1 diabetics as medicare does. This can be modified by a doctors's intervention but just a prescription will not suffice. Any doctor who sets this standard in an advisory position to a health plan in my opinion is guilty of malpractice.

However, there is another way to look at this. If the health plan means that this is all that they will pay for under the plan, it is a different ballgame. That is their right subject to any applicable laws or regulations. However they should be more upfront about it.

More than the increased cost of insulin is the escalating cost of test strips to my mind. The economics of this defies any economic justification I ever learned of other than monopoly, yet there is a lot of competition. Go figure!

Thanks for listening to a Type 1 for 52 years.

Posted by Anonymous on 29 August 2012

This whole subject makes my blood boil! I too test at least 10 times per day. By jumping through hoops my doctor's office, every 3 months, goes through the painful process of getting my prescription okayed for more that 4 strips per day. Of course my prescription benefits don't even kick in until I've met the ridiculously high deductible - after that there's a huge co-pay for the "non-formulary" strips, which includes any brand of strip, generic or name brand. Blood glucose unawareness is a common complication for long-time diabetics, and if you can't even guess what your bG range is unless it's super, super high or near-unconcious low you have a big problem! As mentioned above, regardless of your efforts, there are times when your bG is simply not predictable.
Insurance companies at least in Colorado, have been mandated to pay out at least 80% of premiums received to EITHER benefit pay-outs OR preventative programs. Right after this law took effect, we noticed a huge increase in the number of mailings (and e-mailings) promoting their "great" new program of nurse practitioner availability to "help" you reduce your risks. I have gotten a snail-mailing once to twice a week since the law took effect, along with phone calls at least once a month. The benefits have not changed, and the company proudly advertises their programs and concerns for the well-being of their clients! My one conversation with a nurse consisted of "yes I do that", ad nauseum for exercise, testing, diet, weight control etc. etc...above and beyond the recommendations. No complications for me since 1982. Thank you very much, My A1c is 5.2, my body fat is 15%, and I do very well IF I CAN GET AND AFFORD THE SUPPLIES I NEED!!!

Posted by Anonymous on 29 August 2012

A recent post "hit the nail on the head"- Insurance companies are not saying that you cannot test more than 4 times per day, 3 times per day or one time per day (depending upon the insurance and treatment needs). In fact you are welcome to test 4 thousand times a day if you so desire. You just need to pay for the extra testing yourself. Is this fair if you are the one paying for it? NO!!! But that is the truth of how it currently stands. Insurance companies are a business and they are interested in making money for the stockholders, which means, in part, not spending excessive amounts when not necessary. The same is true for the federal government plans (this is the basis of most of the cases of Medicare fraud you read about in the newspapers).
When it is broken down to the essentials, the issue is "who should spend the extra money, you or someone else? Living with type 1 for 25 years myself, I vote someone else!!! However I do question if it is right to make someone else spend their money on me, if I choose to test more often than what countless studies on testing have suggested - that testing more does not translate into better health for the many, just the few.

Posted by Anonymous on 29 August 2012

When my insurance plan limited me, I also found the solution at Walmart. I also found that their retail prices were cheaper than my co-pay... unbelievable! Then I realized Walmart has done more to make medications & food affordable than insurance companies or the gov't. This changed my opinion of Walmart. You are soooo right... don't they realize they can't make money off a dead person!

Posted by Anonymous on 30 August 2012

You should LOVE this One about Getting Test Strips thru using a Endo under Medicare
1. She ( Endo) was surprised I tested so much and implied I was obessed, testing average of 10x a day and ave 6% A1c's 2. Then I went thru The Ave Times and add a couple of More Of Before and During Driving and then she Understood 3. But She said I had to justify it with Records, so I gave her my Test Meters Past 30 days of Download #'s and that did the trick 4. Butt, Here's the 'Not So Great Part'.... 3 mos later I needed to Renew the Script, but I had to Go back to see the Endo to get tht done.. 5. I spent 35 min. driving there, not to mention the Planning to make sure BG's are Good, 20 min waiting and then? 5 Min with the Endo and then all done.. Just had to give her another 30 days of Test Meter #'s 6. Cost ? $160.00 7. Oh and since I have such Good A1c's? I don't Need a Pump, My Insulin Pens are doing a good enough Job as she said.. Now I told her, I just Love Sticking Myelf 6-8x a day and nite with those Pens and I bet If I was a Girls or Woman and whined about that, You'd Give me a Pump.. And This Endo? Made No Changes, let alone Suggestions On How to Improve things from the 1st time I saw her.. Get another Endo? Sure, The Nearest One seeing new Patients is about 70 miles away and another Woman Endo.. I'll pass thank you very much..

Posted by Anonymous on 31 August 2012

Regarding "nail on the head" above: Do you suppose the insurance companies will spend more of their "stockholders money" by paying for extra test strips as opposed to coronary bypasses and dialysis treatments? NOT. I haven't seen any of the "countless studies" that say testing more than 4 times daily doesn't significantly relate to better health. Am I such a minority? Let's see, 4 times a day: A1c 7.5, 10times a day: A1c 5.2....Heart health excellent, kidneys good. Fifty-two years and counting.

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