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Make Your
Insurance Work For You
As a person living
with type 1 diabetes, I fully understand the importance
of health insurance. But, like many of you, when I was
younger and under the care of my parents, I did not
fully understand just how important it can be.
My parents worked
hard to keep me insured and stressed how important it
was for someone like me with a life threatening disease
to stay insured. When it was time for me to live on my
own, they wanted me to get a job that would provide
health insurance for me and, hopefully, for my wife and
kids as well.
When I began my
career as a chef, many of the restaurants I worked for
did not even offer insurance, much less to a person with
Type 1 diabetes. I was forced to get insurance through
a high risk plan that cost me over $400 per month in
premiums. For a young person just starting out on my
own, this was a lot of money and there were times when I
was tempted to cancel my coverage. I carried this policy
until I began working for Diabetes Management and
Supplies, where I was finally offered health insurance
that was affordable.
This experience
prompted me to learn more about how health insurance
really works. At first, I looked at my insurance
coverage as something I could not change no matter how
poorly it suited my needs. I just had to learn to live
with it. But over time that changed. By verifying and
comparing benefits through all of the major carriers
such as Blue Cross-Blue Shield, Humana, and others, I
began to realize that in order to get the most out of my
healthcare coverage, I first had to become informed on
exactly what my coverage was and understand how to
“maximize” my benefits.
To “maximize” your
benefits means to get the most from or the best deal
possible. There are several ways to do this. When you
order your supplies, how often you order your supplies
and whether you use your pharmacy benefits or your DME
benefits, can make a big difference in cost, especially
if you are someone faced with the dreaded “doughnut
hole” provision.
I have found that
most insurance companies will allow you to use your DME
benefits for most of your diabetic supplies. Most
often, using this benefit will save you hundreds of
dollars per year and leaves your pharmacy benefits for
your medicines, such as insulin, blood pressure,
cholesterol, etc. For those people with Medicare or
Medicare HMO’s, this is very important because of the
gaps in coverage associated with these plans. Buying
your test strips at the drugstore, for example, will use
up your benefits very quickly and cause you to fall
inside the gap or “doughnut hole”. This is true for any
drugstore you may go to. If you use your DME benefit
for these items, it will cost you far less and it will
leave room in your pharmacy benefits for your medicines.
In addition to
testing supplies, some of you like me wear an insulin
pump. Supplies for the insulin pumps are very
expensive, which is why it is important to maximize your
benefits throughout the year when your deductible is met
or maybe even when your out of pocket cost is
satisfied. I never let my stock go below 60 days worth,
especially living in South Louisiana where we could be
evacuated at any moment during hurricane season!
Knowing what your coverage is for your pump supplies is
very important to understand, so that you can plan for
your monthly or quarterly expenses. The last thing you
want is to be uninformed, call to place your order and
be unprepared for the high costs involved. So my advice
would be to read your benefit handbook carefully or call
your insurance company to inquire about coverage.
Please understand
insurance companies are not in the business of telling
you how to save money. They are in the business of
making money. I wish there was a class that I could
have taken to learn all of this, as it would have saved
me a lot of money over the years. I feel obligated to
tell as many people as I can about how to maximize their
healthcare benefits and to save money. With the
situation our economy is in and the healthcare crisis we
are facing, it is vital that we save money when we can
and use our health insurance properly. |