[Diabetes-talk] insurance not covering Prodigy test strips issue

Thu May 12 14:39:52 UTC 2016

Hi Bridgit, 

Your health insurance coverage has not changed, it still covers diabetes meters and testing supplies, and presumably, your copays, deductibles, etc. didn't change either. So, technically, when they told you nothing was changing, they were correct. But, it doesn't feel like it. Let me explain further.

What changed was the prescription benefit formulary. The company that handles your prescription insurance establishes the prices and preferred brands, generics, etc each year. This is known as the formulary. They apparently took Prodigy supplies off their formulary. This is completely within their rights to do so as long as they still have diabetes supplies on their formulary from another supplier. 

So, in the past, they filled prescriptions for Prodigy strips automatically because they were on the formulary. Now, they are not, so to fill them, it has to be handled as an exception. This means they require additional documentation from your physician, and it probably needs to go through a pre-approval process. It is a big headache. It is one means insurance companies and employers use to control costs.  And yes, that means in one sense, increasing their profits, but at the same time, it should mean keeping premiums from increasing so fast for consumers too. 

I believe everyone agrees that controlling costs for health care, in general, is good. But, when it comes at the cost of making it significantly harder to receive your medications or supplies, pardon the pun, it is a hard pill to swallow.

I hope it works out well for you. We can all be thankful that there are at least some relatively low cost options available for buying them and covering the cost out of pocket. But, if you are paying insurance premiums, you shouldn't be paying out of pocket for them. 

Tom

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Bridgit Kuenning-Pollpeter via Diabetes-Talk
Sent: Wednesday, May 11, 2016 10:28 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Bridgit Kuenning-Pollpeter <bkpollpeter at gmail.com>
Subject: Re: [Diabetes-talk] insurance not covering Prodigy test strips issue

What I don't understand is that I've been getting these strips for years, and even placed an order this year, but now all of a sudden, they don't cover them? And I was assured last year things would not change with my coverage, but this is not the first issue I've had this year with my prescriptions. I also don't understand insurance at all.

Bridgit

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Mark Tardif via Diabetes-Talk
Sent: Wednesday, May 11, 2016 7:34 PM
To: Diabetes Talk for the Blind <diabetes-talk at nfbnet.org>
Cc: Mark Tardif <markspark at roadrunner.com>
Subject: Re: [Diabetes-talk] insurance not covering Prodigy test strips issue

Expect them to fight you though, since they will always try to find a way to get out of paying if they can.  Sorry, just my nasty, not so humble opinion.

Mark Tardif
Nuclear arms will not hold you.
-----Original Message----- 
From: Tom Ley via Diabetes-talk
Sent: Wednesday, May 11, 2016 10:48 AM
To: diabetes-talk at nfbnet.org
Cc: TALey at ups.com
Subject: Re: [Diabetes-talk] insurance not covering Prodigy test strips 
issue

Bridgit,

I strongly suspect that if you have your endocrinologist write a 
prescription for the Prodigy autocode strips and have him provide 
documentation to your insurance that you have to use a fully accessible 
meter, your insurance will have to cover them, even though they are not on 
their formulary.

That is how I had to handle it. Large insurance companies want to get the 
least expensive price for test supplies, so they contract with one company 
to provide them all their meters and strips. Since the meter/strip company 
is going to be selling so many to that insurance company, they give the 
insurance company a better deal. For example, my insurance has the One-Touch 
line only. Unless you have a medically necessary reason you can't use 
One-Touch models, you don't really get a choice. But, blindness and the need 
for a fully accessible meter is a reason for them to allow the exception. 
Their accountants may not like it so much, but I don't think they have a 
choice if the prescribing physicians provides the documentation.

Good luck,

Tom

-----Original Message-----
From: Diabetes-talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of 
Bridgit Kuenning-Pollpeter via Diabetes-talk
Sent: Wednesday, May 11, 2016 10:30 AM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Bridgit Kuenning-Pollpeter <bkpollpeter at gmail.com>
Subject: Re: [Diabetes-talk] Test strips and solution for Prodigy meter

This is really great info because I was just told yesterday that my 
insurance does not cover the Prodigy test strips, even though they have for 
several years now. So I need to find an alternative.

Bridgit

-----Original Message-----
From: Diabetes-talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of 
Jolena Foster via Diabetes-talk
Sent: Tuesday, May 10, 2016 10:01 PM
To: Diabetes Talk for the Blind <diabetes-talk at nfbnet.org>
Cc: Jolena Foster <fosterp55 at gmail.com>
Subject: Re: [Diabetes-talk] Test strips and solution for Prodigy meter

I don't know about the recalibration and stuff like that. But I get my 
strips from Maxi Aids. They come 50 strips for 16 dollars or 200 strips for 
67 dollars. Check them out at www.maxiaids.com. I hope this helps.

Jolena Foster

On 5/10/16, Raul A. Gallegos via Diabetes-talk <diabetes-talk at nfbnet.org> 
wrote:
> Hello all. I just joined the list. I myself am not diabetic, but my
> girlfriend is. She uses the talking Prodigy talking meter. I am
> wondering where the best places you have found to get additional test
> strips and calibrating solution. I'm very new to all of this and so I
> want to learn as much as I can. Walgreens sells 50 strips for $60 and that 
> seems like a lot.
> I found 100 strips for $33 from Amazon from a seller with great 
> reputation.
> What sort of things should I watch for when purchasing test strips? I
> know they should not be expired. Also I just learned that if they are
> stored in extreme temperatures that could ruin them as well.
>
> While I am at it, are there only one kind of talking glucose meters
> for blind people to use? I have only seen the Prodigy. Lastly, how
> often should it be recalibrate do?
>
> Thanks, and my apologies if my questions seem elementary.
>
>
>
> --
> Raul A. Gallegos
> Assistive Technology Trainer
> “Any teacher that can be replaced with a computer, deserves to be.” –
> David Thornburg
>
> Voice/Text: 832.554.7285
> Office: 832.639.4477
> Personal Email: raul at raulgallegos.com
> Work Email: training at raulgallegos.com
> Twitter: @rau47 and @AT_Trainer
>
>
> _______________________________________________
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> To unsubscribe, change your list options or get your account info for
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> 0gmail.com
>

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