an update on life (totally rambling here)
About 7 months ago, my husband (then fiance), Chris, and I packed our bags and moved clear across the country from Orange County, CA, to Philadelphia, PA. He started pharmacy school this past fall.
Moving here has been a challenge, to say the least. We live in a 320-square-foot studio (temporarily, for a year), and it's basically a glorified dorm room. I'm talkin' mini-fridge, two-burner stove, no oven, tiny sink with no garbage disposal, etc. It's been especially a challenge for me because I LOVE being in the kitchen and whipping up meals, so I've gotten really creative without an oven to work with (or much space, for that matter).
Because of this, we ate out a lot, which *surprise surprise* made by blood sugars go INSANE. I'd be 260+ one hour, and three hours be in the 50s. It drove me nuts, and it still happens. The food here is definitely different than in California, and I had major issues counting carbs for an accurate bolus.
Add planning a wedding in the mix, and well, let's just say I kind of strayed off path for a few months. Diabetes burnout, they call it.
On January 10, 2009, I married my best friend in a church in Newport Beach, CA. I even posted here a few times asking people for advice on where to put my OmniPod (I settled on my upper thigh, held down by the infamous Spanx, and all went well). Our wedding day flew by, and the next day, we were back in Philly, honeymoon on hold because Chris has classes the Monday after and I didn't have enough vacation time from my new job.
Three months later, my blood sugars are still whack (my most recent A1C, taken about a month ago, is 6.9...good, but I want to get it lower). I'll wake up sometimes at 3am and be in the 40s. One time Chris even had to wake me up-- he woke up during the night and realized my side of the blanket was soaked in sweat. My bg was somewhere in the 30s. I've been so up and down during the day that I've taken to carrying a jug of glucose tablets in my messenger bag; those 10-tab packs won't get me through anymore!
Right now, it's open enrollment with my work's health insurance plan. It's getting me thinking about switching insurance plans (from a POS to an HMO; I'll explain in a bit). I work for a university, so my medical benefits are generally very, VERY good. I'm thinking about asking my endocrinologist about getting on a CGM to catch my lows before I land in the ER or something. The Dexcom Seven Plus looks interesting to me, but I'm open to other options (read: it depends what my insurance covers).
Regarding switching, both the POS and HMO plans are covered by Keystone Health Plan East. The POS covers durable medical equipment at 90% after meeting the $100 deductible. The HMO covers it at 100%, given that it's medically necessary and after a pre-approval process. The pre-approval process scares me, as I've heard stories of people doing up to third-level appeals (!!!!) to get their supplies.
Switching would save Chris and me about $70 a month in premiums, but if $70 eliminates the headache of appeals and jumping through flaming hoops, I'll gladly fork that over. Chris is relatively healthy, thank God, so all this switching and headache would be for me. I'm thinking, if it ain't broke, don't fix it...but 100% coverage on durable medical equipemtn is VERY tempting. I'm not sure what CGM brands Keystone covers, or if they even cover CGMs, but I don't want to run into any roadblocks with this. Next month, I'll be hitting my 16-year-anniversary (1-year-anniversary with the OmniPod on April 30!). I figure, anniversaries call for presents and celebration; why not try and get a CGM for the milestone? LOL
I have no idea who reads my blog here, but umm...what do you guys think about this whole insurance switch thing?
Moving here has been a challenge, to say the least. We live in a 320-square-foot studio (temporarily, for a year), and it's basically a glorified dorm room. I'm talkin' mini-fridge, two-burner stove, no oven, tiny sink with no garbage disposal, etc. It's been especially a challenge for me because I LOVE being in the kitchen and whipping up meals, so I've gotten really creative without an oven to work with (or much space, for that matter).
Because of this, we ate out a lot, which *surprise surprise* made by blood sugars go INSANE. I'd be 260+ one hour, and three hours be in the 50s. It drove me nuts, and it still happens. The food here is definitely different than in California, and I had major issues counting carbs for an accurate bolus.
Add planning a wedding in the mix, and well, let's just say I kind of strayed off path for a few months. Diabetes burnout, they call it.
On January 10, 2009, I married my best friend in a church in Newport Beach, CA. I even posted here a few times asking people for advice on where to put my OmniPod (I settled on my upper thigh, held down by the infamous Spanx, and all went well). Our wedding day flew by, and the next day, we were back in Philly, honeymoon on hold because Chris has classes the Monday after and I didn't have enough vacation time from my new job.
Three months later, my blood sugars are still whack (my most recent A1C, taken about a month ago, is 6.9...good, but I want to get it lower). I'll wake up sometimes at 3am and be in the 40s. One time Chris even had to wake me up-- he woke up during the night and realized my side of the blanket was soaked in sweat. My bg was somewhere in the 30s. I've been so up and down during the day that I've taken to carrying a jug of glucose tablets in my messenger bag; those 10-tab packs won't get me through anymore!
Right now, it's open enrollment with my work's health insurance plan. It's getting me thinking about switching insurance plans (from a POS to an HMO; I'll explain in a bit). I work for a university, so my medical benefits are generally very, VERY good. I'm thinking about asking my endocrinologist about getting on a CGM to catch my lows before I land in the ER or something. The Dexcom Seven Plus looks interesting to me, but I'm open to other options (read: it depends what my insurance covers).
Regarding switching, both the POS and HMO plans are covered by Keystone Health Plan East. The POS covers durable medical equipment at 90% after meeting the $100 deductible. The HMO covers it at 100%, given that it's medically necessary and after a pre-approval process. The pre-approval process scares me, as I've heard stories of people doing up to third-level appeals (!!!!) to get their supplies.
Switching would save Chris and me about $70 a month in premiums, but if $70 eliminates the headache of appeals and jumping through flaming hoops, I'll gladly fork that over. Chris is relatively healthy, thank God, so all this switching and headache would be for me. I'm thinking, if it ain't broke, don't fix it...but 100% coverage on durable medical equipemtn is VERY tempting. I'm not sure what CGM brands Keystone covers, or if they even cover CGMs, but I don't want to run into any roadblocks with this. Next month, I'll be hitting my 16-year-anniversary (1-year-anniversary with the OmniPod on April 30!). I figure, anniversaries call for presents and celebration; why not try and get a CGM for the milestone? LOL
I have no idea who reads my blog here, but umm...what do you guys think about this whole insurance switch thing?
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Comment by Suzanne on April 10, 2009 at 6:10am -
Congrats on all the life changes that you are going through! What an exciting time for you and your hubby!
Picking insurance is tough to say the least. Here are some questions to consider as I have been burned by insurance switches before and it cost me a TON!
1. is there an overall deductible for the policy you must meet? I was told they would cover me 100% on my pump & CGMS supplies but what they failed to tell me was I had to meet a general $1500 deductible first!
2. How easy will it be to go to the doctor or specialist of your choice? In Georgia an HMO plan has less docs you can go to compared to the POS.
3. What is the pre-approval process for the HMO? See what hoops you would have to jump through to be more informed.
4. Do the math, chart out what supplies cost and what you would pay under both plans counting for all the supplies you currently get and what you would pay with the CGMS as part of your care. Keep in mind the monthly cost that comes out of your check too (like that $70 savings)
5. Is there a cap on what either policy will cover in the course of a year or over your lifetime? I have seen people get burned by this one before so ask to be sure.
6. What brands will they cover of pumps and CGMS? Some insurance companies will not cover certain brands of CGMS or even the ominpod. Make sure they cover what you want!
Suzanne
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Comment by faye on April 10, 2009 at 8:29am -
wow suzanne, THANKS! this is the sort of list i was looking to compile.
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Comment by Sweeter Cherise on April 12, 2009 at 5:36pm -
Congrat's on getting married and moving to the East Coast. I am sorry about the problems you are having with your blood sugar. I agree with Suzanne. Alot of insurance companies will not cover the omnipod or CGM. I would call the insurance company to find out. Think about copays to doc visit's also.
Cherise
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Comment by Betty J on April 12, 2009 at 6:45pm
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Hi Faye and welcome to Philly! I'm sure living here is quite different from CA but you'll adjust. If you would like a refresher course for D, just outside of Philly we have the guru of D, Gary Scheiner CDE who was recently guest speaker at DTF chat. He's located in the area of Wynnewood, PA.
I've always paid for the best healthcare I could afford and in this area of the world I've always chosen the Blue Cross/Blue Shield also known as the Blues. Healthcare has always been number one priority with me. When I was dxed many,many years ago healthcare was almost unaffordable unless you had a job with healthcare coverage and my parent did.
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Comment by Ryan on April 12, 2009 at 6:47pm -
WOW!!! I am amazed at how many Type 1's get married nowadays!!! I can't imagine being married and being type 1!!
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Comment by faye on April 12, 2009 at 6:55pm
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I agree, Betty. So far, Keystone Health Plan East (which is Independence Blue Cross) has been covering my pods-- at least, I haven't heard anything from them and I'm on my second shipment since I've had this insurance! I'm going to ask my endo for recommendations for CGMs. Since it's open enrollment right now, there's a health fair on Tuesday so I'm going to that and asking the Keystone reps if they cover/which CGMs are covered. Hopefully I'll get a more concrete answer than "call this number"!
Ryan...why do you say that?? I'm a little baffled by your statement...
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Comment by Ryan on April 12, 2009 at 8:14pm
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I guess I just think Type 1's should not marry. It is not fair to the spouse or if you have kids. Diabetes is a solitary disease!!
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Comment by faye on April 12, 2009 at 8:36pm
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Wow. I don't even know what to say to that, but that is ridiculous and your "woe is me" attitude is not cool. I have to disagree with you; diabetes is NOT a solitary disease. Yes, you are one person who has it, but everyone has a support system (isn't that why you're on this forum in the first place?).
As for my husband, it's not like we got married and then I said, "Surprise! I'm diabetic!" THAT is not fair. But he knew from the day we met that I had type 1. Obviously he doesn't think it's "unfair."
Also, who says type 1's can't have healthy kids? Obviously parents who don't have type 1 can have kids with it, so it can certainly work the other way around.
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Comment by Ryan on April 12, 2009 at 8:45pm
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Umm..I don't have a " woe is me" attitude!!! I have had type 1 30 years and I handle it very well, I have a good career and a good life!! i just choose not to share my diabetes with most people. And I never tell the women I date. i have dated my current gf for 10 months and she has no clue I have diabetes!!! Why would I tell her??? That be weird!!
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Comment by faye on April 12, 2009 at 9:03pm
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no, i didn't mean that you had a crappy life. i was referring more to your "diabetes is a solitary disease"/"i'm all alone in this" attitude.
i personally would find it weird if someone i'm sharing my life with didn't know about this huge part of me. what if you go low and pass out? what if she walks in on your giving yourself a shot or testing your blood? what if there is some kind of medical emergency?
trust issue aside, it's also practical. my husband knows i'm not messing around when i say i'm low and need candy.
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