Insurance of the Year Club

We're switching insurance again.

Of all the employer-sponsored insurance plans offered for 2019, our current plan will now be three thousand dollars more expensive for the year than the least expensive one. The cheapest of the three, of course, is the one we've never had. We will sign up for what the company calls a 'gold plan,' and the system is tiered so that all insurers in the gold plan cover similar medical services, charge the same copays and have the same deductibles. The gold plan's coverage fits our high medical use and costs, and so is our best choice. But the per-paycheck cost is staggeringly different for each plan.

We did our homework, which was easier this year after lots of practice last year. The new insurer will cover all of our current doctors and drugs (though still not Novolog which stinks). It's possible we'll be able to escape Edgepark's grip since other DME providers are listed, but I'm not holding my breath since they are still one of the options. And while I generally subscribe to the adage, 'the devil you know is better than the devil you don't know,' $3000 is a lot of money.

The big risk, the one we can't get a clear answer on, is whether there will be hoops we have to jump through to get coverage for diabetes-related equipment. We delved pretty deep into the new insurer's website and made phone calls to learn about diabetes coverage and could not come away with a clear answer on whether we'd have to prove my daughter's need for an insulin pump and CGM before coverage is granted. Between reading and conversations, the possible answers range from 'you might need a letter of medical necessity from your doctor' (which is pretty standard), to needing to submit tons of documentation, to maybe they don't cover CGM unless it's some sort of dire situation.

I'm well aware that we're incredibly fortunate that we have access to insurance at all. That we've consistently had access to really good insurance, which for the most part covered what we needed with little to no hassle, is unusual. Maybe that's about to change, but after 16 years at this, I'm prepared to use every tool I now have up my sleeve to fight for what my daughter needs. Hopefully we'll repurpose that $3000 wisely. If need be we'll spend it on things that aren't covered. Or on a little getaway to help me recover from a year of insurance fights.




via Adventures in Diabetes Parenting