How the Affordable Care Act continues to affect this Diabetic

The Affordable Care Act, as I understand it, was designed to make insurance more accessible for people who were on the lower end of the income scale and wanted/needed insurance. The only problem is that it did this by reducing benefits and making medical care more expensive for people who had good insurance.  The President promised that "If you liked your insurance you could keep your insurance." Unfortunately this has not proved to be true.

In March of 2013, after I had just ordered a new insulin pump and begun using the DexCom Continuous Glucose Monitor I was informed that the insurance plan my company had chosen for the employees was not ACA approved. We were going to be forced to change insurance plans. Our plan was a good one, I'm not sure why it didn't meet ACA standards.

25 dollar doctor visits
40 dollar specialists
500 dollar deductible
100% coverage after deductible was met
The Freestyle test strips I was using were on the highest tier but covered and with a freestyle card I was getting them for 15 dollars a month.
OmniPod insulin pump was available ordered straight from OmniPod with minimul problems
DexCom was not a real problem.

Among the insurance plans presented as approved plans by BC/BS not one offered what is so important to me that 500 deductible with 100% coverage after deductible is met. Looking through approved plans offered by BC/BS and UHC the closest we could find was a UHC plan that looked more like this.

35 dollar doctor visits
50 dollar specialists
1000 dollar deductible
100% coverage after deductible is met
Freestyle test strips not available with help from freestyle and would have cost over $100 a month.
OmniPod not really covered and each order for supplies needed clinical notes and 3 months of blood sugars submitted. Forced to switch insulin pumps.
DexCom only covered with extensive doctors notes.

All that being said, the cost of the plan is less but all that savings is going to go for making up the difference in coverage and since it's not being taken out of my paycheck pre-tax, Washington gets a cut of that income. Does this sound Affordable to anyone?

It turns out all of the issues with inferior coverage are just the beginning of problems caused by changing insurance. If there is one thing I'm tired of it's Doctors offices and Medical Supply companies using the insurance issue as an excuse for poor service. Since UHC does not work directly with DexCom I have to order supplies through an UHC approved medical supply company. Below is the letter I wrote to DexCom last night about how their distributor has handled my last couple of orders. Thank you ACA for making my life so much simpler and more affordable. (Yes that's sarcasm)

My last order of supplies was in July. I knew that I had 500 dollars of deductible left so I kept waiting for a bill from Byram Healthcare. At the beginning of September I received a letter from UHC stating that they had not been able to make a decision on the payment of the claim for supplies because they hadn’t received requested information from the service provider. The letter stated that no action was needed on my part that it was only informational. the envelope included a copy of the letter that was sent to Byram for more information and doctors notes.

At the beginning of October I received a letter from UHC saying that my claim had been denied because the requested information was never sent. I called Byram Healthcare to see what was going on and the billing rep told me that I owed them all the money because I didn’t follow up with the insurance and get them the information they requested. I told them I had a copy of the letter that asked them for the information and told me that there was no action needed on my part. The person I was talking to on the phone told me there was nothing they could do and I’d have to handle it with my insurance.

I then called UHC and explained the situation. They told me I was correct and that they had a copy of the letter I was referencing. They asked me if I could remain on hold while they contacted Byram Healthcare for me. When UHC came back to the phone they told me that they were faxing a copy of the letter to Byram Healthcare and it should all be taken care of in 10 days. Since that time I have been waiting again for the bill from Byram. I plan on paying it with the end of my Beneflex account for the year.

Today I called Byram Healthcare to order more supplies. (I know I extended the life of some of my sensors) I was told by the Byram Health representative that I had an outstanding bill that needed to be paid and she asked me how I would like to pay it before she would input the order. I explained that I hadn’t even received an invoice yet. She said that they had been working with the insurance and the insurance finally told them that this much wasn’t covered by the deductible. The invoice would go out today. I asked if I still had to pay before I could order something else without receiving an invoice yet. I was worried about actually having the invoice as a receipt for beneflex if they needed. She indicated that the order may be held up until the outstanding amount was paid and complained about how much information the insurance company had asked for. I asked if she was suggesting that was my fault. She said no but it was the explanation for the insurance process taking so long. I mentioned that this was not the reason that it took so long. I explained that it took so long because they had not submitted the requested info in July.  In the end, I said that I would wait for the invoice to pay the order. she told me she would submit the new order but I’m not sure when things will actually move forward.

I just thought you should know how a company that is dealing with your products and customers that your salespeople are so good to during the sales process are treating those customers. It has been a very unfortunate and unprofessional handling of the situation and I’m worried that my ability and desire  to order the dexcom supplies may be hurt by it.