What a Difference a Year Makes

Many of you know that I am a type 1 diabetic which means I need insulin to live. My body no longer makes it. I was officially diagnosed in 2001 (the day before 9/11) but I went through my second pregnancy with it - although at the time I didn't know I would have to stay on insulin.

I have been "pumping" since 2002. I wear an insulin pump instead of having to take daily shots. I used to take 4-5 shots daily and the pump has given me a lot of freedom in that regard. Pumps are expensive but they don't last forever. My original pump began to malfunction. It was really minor overall but every time I changed out the battery on it (about every other month) it would completely erase all my settings. It was annoying but the pump still worked. However, it did need to be replaced.

I blogged back on December 21, 2006 about the pump I hoped to get. It was relatively new on the market and the best part for me was that it was wireless! I would no longer be connected by a tube to my pump. Another great selling point for me was the cost. It was under $1,000 & most pumps run at least $6,000. My current insurance policy only covers up to $3,000 of "durable medical equipment." I applied and the issues began.

It took me about nine months to finally get approval for the pump. I ended up appealing my insurance twice in order to get this approved. It was a very long and frustrating process. I blogged again on July 20, 2007 about finally getting that approval. You can see my joy coming through the post and again when I posted on August 13, 2007 when I went live with my new pump. If I only knew.....

Fast forward a year....

About four months ago I received a phone call at 4pm on a Saturday afternoon from my pump company, Omni-Pod. The rep was letting me know that my insurance company, Anthem BC/BS of Maine, had not paid them anything for any of the supplies they had been mailing me. I had been getting supplies for a year - this was three shipments of three months each. The grand total was $3,105. That's a lot of money to owe to someone.

During the course of the phone call, after I was told this & started to get upset about the fact that the first time I was hearing about all of this, I was assured that I would be mailed out a "transition" supply that would be another three months "free of charge." I took away from that phone call that I needed to get this issue fixed.

Monday morning I began calling Anthem. It took me the entire three months to finally get this resolved. Seriously. It's been awful. Every time I called I had to explain all over again what was going on. I had some reps try to tell me I didn't have approval for this. Well, it certainly didn't make sense to not have approval for my supplies since I had approval for the pump!

I called on June 1st and it seemed all would be fixed at that point. So I waited. I waited to see if it would show up on-line that it had been paid as I had been assured it would be. I waited and I waited until on August 1st I called again.

That's when I found out that not only had it finally been paid, but that Omni-Pod had even cashed the check back in July. I was thrilled thinking that all had been fixed. So I called Omni-Pod to make sure they would be sending me my next three months worth of supplies.

And that's when I found out that Omni-Pod has implemented a new company policy. They are no longer working directly with Anthem BC/BS of Maine (thank you so much) due to all the issues they have been having with payment. This leads me to believe I'm not the only Omni-Pod customer in the state having issues with Anthem and timely payments (don't even get me started on Anthem and my children's dental coverage- UGH!). What I was told is that I would have to sign a waiver and I would have to pay for my supplies out-of-pocket to the tune of $345.50 a month since if it makes it easier I can get this monthly. Then I can go to Anthem directly to get my money. Yeah right. I told the person I spoke to NOT to send me a waiver as I would not be signing anything and hung up.

Currently I'm trying very hard to find a go-around to get my supplies. I called the one DME (durable medical equipment) supplier in my state who helped me before to get my supplies for my last pump. They told me that Omni-Pod refuses to sell to them. ::sigh:: I have another call in to a place that my provider told me about and they are going to look in to it for me.

At this point I have resigned myself to going back on shots. It won't give me as good control with my blood sugar levels but at this point I really have no other choice. I have thought about going back to my old pump since I still have it somewhere, but I don't know if it would even work at this point and even if it does I still have to deal with it clearing my settings when I change out the battery.

Dealing with diabetes on a daily basis is hard enough without all this other stuff thrown in to the mix. Needless to say I'm not thrilled with either Omni-Pod or Anthem at this point. I find it ironic that in the last two days I've been asked to do two surveys on Anthem by independent research companies. When asked today on a scale of 1-10 (10 being the best) if I would recommend Anthem to someone else I gave them a 4 and that was being generous. Please pray I get this resolved soon. I'm so tired of dealing with it.