Sarah M

Director of Operations
of DiabetesSisters

In early 2016, I changed jobs and went to work for a small nonprofit after working for a large nonprofit and several universities over the previous 20 years. We moved to a different state just a few months after the job change. I had to research, purchase, and maintain medical insurance for my family and myself several times in that one year.

In the course of 6 months, my family and I had medical insurance through 4 different plans. The first was employer-based through my previous job; the second was through Covered California (the state-run marketplace/Affordable Care Act); the third was through Connect for Health Colorado (state-run marketplace/Affordable Care Act); and the fourth was through my wife’s new employer. Each switch meant not only finding what sounded like the best plan for each of us (the most/best coverage for monthly premiums we could afford) but also learning how to use each plan once we were covered. This included benefit minimums and maximums, preferred providers (and labs, pharmacies, and urgent care), formularies, and plan definitions and coverage of diabetes supplies such as strips, insulin reservoirs and tubing, and CGM sensors.

I was vigilant about making the premium payments to ensure that our coverage didn’t lapse.

Sometimes it’s hard for me to remember, but life often happens while I’m busy making my best (other) plans. Even though I worked really hard to make sure we had coverage based on our various needs AND that we could afford, at times things just go really off track. Six weeks after my wife had started her new job with insurance benefits, and we’d enrolled in and paid for the coverage, we still hadn’t gotten our proof of insurance cards with our group and member numbers.

I’d called the insurance office several times and was told the cards were in the mail (from within the state), but they did not show up. I’d called to order insulin and pump supplies but was told that neither I nor my new insurance plan could be found in their databases. The diabetes supplies kept dwindling. I kept calling.

The same day that I inserted my last insulin pump site, I finally found the physical address for the insurance plan’s local office in our town. I got the information and drove across town just before 5 pm. The office seemed a little deserted, but I found one person to ask through my tears: “When can I order durable medical equipment: specifically, insulin pump tubing? This is the last one I have.” I pulled my pump off my waistband and gestured with it. She started talking about how I needed to wait for my insurance card to arrive, and then I could give that information to the pump supply company to place an order.

“No, I’ve been waiting for weeks. WEEKS. Almost two months, actually. No insurance card as of yet. I’ve made multiple calls to your customer service number, and each time I’ve been told that the card is in the mail. But it isn’t. Who can help me with this? Right now?”

After quite a bit of commotion, I was connected with the staff person in charge of prior authorizations, who called the pump manufacturer and mail order pharmacy directly, gave them my insurance information, and authorized and placed my orders for me right there. It turned out that her son also lived with type 1 diabetes for many years and she knew how desperate I was for supplies.

During these months I operated much more in survival mode (“how many more pump sites or bottles of insulin are left, and when can I buy the next round?”) than in optimal diabetes management mode (“how much time is my blood glucose spending in a target range?”). However, I did keep a pretty tight range on my continuous glucose monitor’s app and paid some attention to how much time my blood sugars stayed within that range. I made adjustments to insulin rates based on how massive the various stressors were, and how much sleep I was or wasn’t getting. I tried to laugh, relax, and spend time with my family doing fun things as well as unpacking and painting. The new puppy we adopted a few months after moving helped us discover our new neighborhood, with plenty of walks that helped my blood sugar as well.

Getting help from the prior authorization person made all the difference, too.