Spare a Rose

Laddie_Head SquareThe Diabetes Online Community has come together again in 2014 to sponsor the Spare a Rose, Save a Child campaign.  The message is simple, but powerful.  Buy one less rose this Valentine’s Day and donate that $5 to the Life for a Child program sponsored by the International Diabetes Federation (IDF).  Your gift of $5 will provide a month of insulin and diabetes supplies for a child in parts of the world where these life-saving medications and supplies are desperately needed.  Or consider donating the equivalent of a dozen roses and giving a year of life to a child with diabetes.

728x90tag_Spare a RoseThe website for Spare a Rose, Save a Child was created by members of the DOC as a source of information about the Spare a Rose program.  If you are a blogger, you can find links and images at this site to use to spread the important message about this campaign.  This one-page information sheet will tell you everything you need to become involved.

If you wish to donate, use this donation form to send your gift directly to the IDF using PayPal.  Please note the down arrow that gives you choices of how much to donate.  (Spare 1 Rose = $5 = 1 month of Life for a Child. 2 Roses = 2 Months and other options up to 2 dozen roses for 2 years of life for a child.)

As we approach Valentine’s Day 2014, let us all be generous in sharing our bounty with children all over the world.  To us, a rose is small.  To a child with diabetes, that rose represents another day, another month, another year of life.

To donate, click on this image.

To donate, click on this image.

Hey, He Needs his Insulin!

Sue B_Head SquareWho would ever think that it can be difficult to get insulin for someone on Medicare?

For the past 15 months my husband Marc has been on Medicare. During most of that time we have been fighting for Medicare coverage of a CGM because he has hypoglycemia and hyperglycemia unawareness. We thought that the CGM would be the biggest obstacle that we would encounter in dealing with diabetes under Medicare. It turns out that while a CGM is an extremely important device for Marc, insulin has turned out to be an even bigger obstacle.

Under Medicare Marc previously got his insulin with no problems because it was being billed under Part D. As a result of the deductible on his supplemental insurance policy, he had a substantial co-pay for the insulin. Recently he found out that his insulin should be billed under Part B of Medicare because he uses an insulin pump. Insulin under Part B provides significant savings because there are no co-pays and the cost is excluded from the donut hole gap in coverage. The Part D billing was partially our mistake because we didn’t understand Part D, Part B or any other parts for that matter.

Now we come to these past few weeks when once again Marc needed insulin. We were told that CVS Pharmacy has a contract with Medicare for insulin.  Marc took his prescription over to CVS which is only 3 minutes from our home. The pharmacist told him that she would run it through to see what the charge would be under Part B. After three days, Marc received a call from CVS saying that his co-pay would be $1900 for a three month supply. We could get no answer as to why the charge was so much.  Can you imagine how quickly Marc sent me to the pharmacy to pick up the script?

Because he’s a working stiff and I’m a stay at home person (I can’t say mom because the kids are grown and out of the house), I was assigned the task of trying to get insulin. I first called CVS’s customer service line. The wait to speak to a customer service representative was approximately 30 minutes. When I got through and explained what the situation was in trying to get the prescription covered by them under Part B, she put me on hold for another 30 minutes while she tried to contact the CVS Running into brick walls_2pharmacy that we use. She was told that they couldn’t tell her anything because they didn’t have the insulin script in their possession and there was nothing in their computer system. So much for the waste of 1 hour. I did straighten up the house during the long wait so at least some good came out of the call. Thanks to the person who invented the cordless speaker phone.

My next call was to Medicare. Again, I had to hold on for about 10 minutes until someone came on the line. My question to Myra (we got to be good friends during this conversation) was whether a diabetic on an insulin pump would be covered 100% for insulin under Medicare Part B. She asked me to hold while she did her research and when she came back on the line, she told me “most definitely” the insulin would be covered and the cost would not go towards the donut hole. Glory be. Finally concrete information that confirmed what I had been previously told. Maybe Marc would finally be able to get his insulin.

I asked her if she could give me the name of Medicare Providers who dealt with Part B insulin and once more I was asked to hold. When Myra came back on the line, she said there were at least 20 providers for insulin and she proceeded to give me a list of the names and phone numbers. I thanked her profusely and after an hour on the phone with her, I hung up thinking that finally, finally we had hit pay dirt.

I called each and every one of the so-called providers of insulin on the Medicare list and not a single one of them provides insulin. One pharmacist told me that they don’t handle insulin for Medicare because Medicare doesn’t reimburse them enough money to make it worthwhile. Now, I ask, what is wrong with this picture?  How can Medicare not know who supplies insulin? More importantly, how can the reimbursement be so low that pharmacies won’t supply it for Medicare recipients? I was at my wits end after all these calls. Marc needed insulin and I didn’t know what to do next to get it.

Suddenly, a light bulb went off in my head and I decided to call Walgreens.  Somewhere I had heard that they supply insulin to Medicare recipients under Part B.  Mind you, I have no Walgreens in my area and the closest one is 45 minutes away. But at this point, I probably would have traveled two hours to get the insulin. The call was answered immediately by a pharmacist who confirmed that Walgreen’s is a Medicare Provider for insulin. I felt like jumping for joy. I was told what was needed to get an approval from Medicare:  things like my husband’s height and weight, (thought this was strange), pump manufacturer, serial number, date it was purchased and whether it was a private purchase or an insurance company purchase. We faxed the information Running in circles_2immediately and were told by the pharmacist that she didn’t see any problem in getting Medicare to approve the insulin, and we should be able to pick it up on Sunday. Three days later I received a call from the pharmacist informing me that they could not supply the insulin. She said that when he signed up for Medicare, my husband waived his right to certain things. She couldn’t explain what those things were.

Now we were back to square one. Once again I called Medicare. When I mentioned what Walgreen’s had told us about waiving rights, Fred (I was establishing quite a lot of first name relationships with Medicare reps) said there was no such thing.  You don’t waive any rights when you sign up for Medicare. He said I should call Freedom Blue, Marc’s supplemental insurance company. I’m thinking “here we go again.” This whole thing was becoming like the movie “Groundhog Day”.

Nevertheless, I called the insurance company and was told that the only approved supplier under our contract was Liberty Medical. I don’t understand why I wasn’t told this a week ago. Liberty Medical was one of the suppliers that we had originally called when we started this whole process and they gave us a quote of $1100 for the co-pay. Now I was placing another call to Liberty Medical and after holding for 20 minutes, the customer service rep looked up my husband’s records and said that they could foresee no problems with supplying the insulin. So with fingers crossed, I ordered the insulin and hoped that this time we would get it.

One day later, UPS knocked on our door with a boxful of insulin. I felt like I had won a huge battle but was continuing to holding my breath hoping that we wouldn’t get a bill for a co-pay. Last week we got notification that Freedom Blue has accepted the amount that Medicare paid for the insulin. What a thrill that after a harrowing week of spending more then 11 hours on the telephone (most of it on hold), the insulin is finally in our fridge and we don’t have to worry about a large co-pay.

Success_3As a non-diabetic spouse of someone with Type 1, I give thanks to those in the diabetes online community who have guided me in my daily journey to learn more about diabetes. Because of you I now know that insulin for an insulin pump is considered durable medical equipment under Medicare and is covered under Part B.  There is no co-pay and it doesn’t go towards the donut hole…which thankfully will be eliminated in 2014. I hope that this information will be helpful to anyone reading this blog who might not understand Part B.

My whole reason for writing this blog post is to say once again that “diabetes is a challenge in and of itself.  There shouldn’t be these issues that make a diabetic jump through hoops to get what he or she needs.”  I seem to use this quote in almost everything I write and everything I say.  Let’s face it…a person can live without many things. One of those things is not insulin.

There is something horribly wrong with the system.


Laddie_Head SquareSometimes I jinx myself.

It seems that every time I write a post or just look in the mirror and think “Wow!  Things sure have been going well…” my blood sugar decides to go off on wild bumper car excursions.  Sometimes I can blame myself for the results–oh yes, I shouldn’t have had that double bowl of chocolate ice cream last night–but just as often it’s just one of those things.  It’s a reminder that hard work and good decisions usually lead to good results but that every so often diabetes throws a temper tantrum trying to remind me who’s in charge.

I get oodles of motivation when I do things right and I get good results.  However, when I think that I have done things correctly and I get bad results, I am very quick to say “What the hell!” and go off the deep end with bad decisions.

When the numbers are good, it’s easy to think that I am in control of everything that affects my blood sugar.  I can take my insulin adhering to all of the preset and tested ratios in my pump.  I can show incredible willpower and have an egg and spinach omelet for breakfast when I am starved for a bowl of cereal with bananas and milk.  Oh, how I do miss cereal for breakfast.

Things Going WellWhen the numbers are bad, I usually blame myself.  If I take responsibility for the good numbers, it seems logical that I should take credit for the bad numbers.  But there are times that I eat a low carb breakfast with an appropriate insulin bolus and my blood sugar soars into the 200’s.  If I understand correctly what books tell me, some of these morning blood sugar excursions are the result of hormones screaming at my liver to pump out glucose at the same time they try to interfere with the action of my insulin.  But where were those hormones yesterday and the day before when my body thought the same breakfast was hunky-dory and my numbers were great all morning.

Recently I participated in a study that was investigating whether blood sugar rises at the end of the two or three day life of a pump infusion site.  Today was the third day of what has been a fine infusion site, but when I was high through much of the day, I changed out the set.  My problem is that I usually go high when I have a new infusion set.  So I was high because of the old set and then high because of the new set.

So today I am ranting.  Highs are much more enjoyable when you have the guilty memory of a hot fudge sundae.  But I have been doing a really good job of eating low carb lately and totally ignoring the call of chocolate covered donuts.  So this isn’t fair.  You mean diabetes doesn’t play fair!  Wow, that’s not very nice.