Medical Insurance

[LuckyCharms]

I spent 3 hours on the phone yesterday with my insurance company.

They are not filling my prescription for a Dexcom transmitter (continuous glucose monitor). They need a pre-authorization for something I've been using for years for Type 1 diabetes, a disease that doesn't go away.

They sent something to my doctor, but whatever they sent was incorrect.

The rep at the insurance company ended up getting frustrated and literally hung up on me, mid-conversation, after I was on hold for a few hours. I'm very polite on the phone, I don't curse, and I don't raise my voice.

I've done some research on Reddit, and apparently this is a thing now...insurance companies just hanging up on you.

My wife used to hold a big position at an insurance company, until she decided "no more of this shit", and got a different career.

Getting hung up on makes you feel violated and insulted. I had a bit of a breakdown after this phone call, and my wife is taking over this nonsense for me since she can navigate it better.

I expect her to be on the phone for hours today as well.

I don't have the words to express my fucking anger.

[Clouds Passing]

1. We really need nationalized healthcare. The situation has been dire for a long time.

I am so sorry you are going through this LC.

[LuckyCharms]

3. It's so bad, Clouds Passing.

I'm known to be a "fixer", but I can't fix this. I can't handle this shit.

And it's all by design...they want you to just give up.

[Clouds Passing]

5. It is disgusting beyond belief. A massive conspiracy and even bigger scam to commoditize people's health.

[True Dough]

2. Terrible. You deserve better, Lucky.

I suspect it's not just the insurance companies that "conveniently" hang up on customers. Phone and internet providers are also notorious for putting clients on hold and then the call drops after 30 to 60 minutes, especially when you're calling to cancel something and indicated as much by pushing a particular number on the dial pad.

It is beyond frustrating!

[LuckyCharms]

4. Took 10 minutes just to get through the AI prompts

and then when I got a real person after being on hold forever, she just fucking hung up on me mid-conversation!

Mid-conversation!

From what I'm reading from people who actually work at these companies, it's a well-known, planned, and accepted tactic.

[jfz9580m]

16. God..those AI prompts are the worse

I am pretty sure by now that some mangled, malicious and buggy tech, sleazy cryptography and slander have ensured I go straight to the spam folder in many cases..
I think I have a bunch of dead emails, links etc and I am just yelling solo into the void. Oh well..vents frustration and really it isn’t worth reading.
But I will pushback for real some day..

[haele]

6. All the insurance companies are proudly announcing they're using AI

"To ensure everyone is getting the best care at the best price" or some other such nonsense.
So now, instead of getting a nursing or other medical field burnout as the middleman for your treatment, you get Grok. And Grok supposedly makes fewer mistakes and can't be argued with or sued...so it's cheaper.

[leftstreet]

7. No one should be profiting of our healthcare

DURec

[Donkees]

8. ''I don't have the words to express my fucking anger.''

Shift focus in order to protect your eyes...

"it's the road that is crossing the forest.''

[HeartsCanHope]

9. I'm sorry Lucky Charms. This should not be this way.

I hope your wife can straighten this out for you. Sending you both a big hug and love and light.

[AverageOldGuy]

10. We had a problem with CGM

Four yeas ago wife tried it, could not tolerate the sensor, did not use it.

Now she must have one. They would send the monitor but not the little handheld device to which the readings are sent because you can only get one of those very five years. Had to pay for it -- $85.00.

[LuckyCharms]

21. That would be the receiver...

Can your wife use the app on a smart phone instead of having to deal with getting a new receiver?

I use both the receiver and the app for redundancy, in case one of them fails.

[Ms. Toad]

30. We can only transmit from the sensor to one device.

Any other receiver gets the transmissions from the primary device.

[Maru Kitteh]

11. I just got a bill AFTER insurance for a simple echocardiogram, $1300. BCBS

covered $388 of the $1700 charge.

I feel too defeated to even pick up the phone, and wouldn’t know what to say to open the right doors if I did. And I’m a NURSE.

[LuckyCharms]

23. That's EXACTLY how I feel...defeated.

Seriously, I'm known for fixing stuff. I can fix almost ANY problem because I am tenacious as hell, and I "shake the tree from the top".

But I can't fix this shit.

I NEVER give up...but this is making me want to give up.

"I feel too defeated to even pick up the phone'.

That's exactly how I feel.

What are you going to do when they just hang up on you?

Now I have to start writing letters? Going to court?

When the insurance premiums are paid $1,500 a month out of pocket, and that's AFTER her employer's contribution to the premium?

[Ms. Toad]

32. It's near the beginning of most insurance years.

Is it that high because of the deductible? Start by checking your EOB. That should explain why it is so high.

You could call the insurance company and ask them to explain why you were charged so much.

Generally, once you have paid the deductible for the year, as long as you're in network, you can't be charged for amounts higher than the providers contract with insurance.

[LuckyCharms]

41. No, that's the thing. it's not a high deductable plan!

It's a normal deductible plan.

The premiums went up, I think about 30% after the ACA subsidies were eliminated. And it's not even an ACA plan!

The increases in the ACA premiums because of the subsidy elimination flowed through to regular insurance too!

[Ms. Toad]

42. Sorry for any confusion -

This was intended for MaruKitty (with the high bill)

[LuckyCharms]

44. Ooops. My fault! I'm sorry.

[Jacson6]

12. FYI, Dexcom G7 censors are $500 each. I have a VA prescription for Freestyle Libre and they are half the price. n/t

[dflprincess]

13. My friend is a Type 2 diabetic

And, thanks to her Dexcom monitor (her opinion) she's off insulin and controlling her diabetes with diet & exercise (I know you can't do that with Typev1.)

So, because she's no longer insulin dependent, her insurance won't cover the Dexcom. She's using a cheaper, less accurate device now that she can afford to pay out of pocket for & her A1c has gone up again.

[LuckyCharms]

26. Infuriating.

[mountain grammy]

14. I'm sorry

Our stinking rotten healthcare system is why we have a stinking rotten president and we all pay the price.

[Vinca]

15. You should file a complaint with whoever regulates insurance companies in your state. Outrageous.

[Soul_of_Wit]

17. Folks die from complications due to diabetes

Healthcare insurers play a part in these deaths, by delaying and outright denying coverage for durable medical equipment. We mourn a family friend who died this way.

[waterwatcher123]

18. The insurance model is all about denying claims.

It is not fun - but maybe pay for the medication and then go after them in small claims court (it is not as intimidating as it sounds). Most states have self-help guides so you can file and present the case appropriately. The insurance company will fold before your case gets to a judge.

[Martin68]

19. That sucks. Insurance companies are the worst sort of parasites, feeding off the sick and dying.

In a good world, their job would be to help us all and get paid a reasonable salary to do so.

[milestogo]

20. A couple of years ago I had a problem with Medicare.

Calling them meant waiting on hold for 45-90 minutes, only to be told I needed to call a different office.

Ultimately I asked my Democratic Senator's office to intervene and they did. And this was BEFORE TSF/DOGE started fucking everything up. Medicare/Social Security has long been understaffed. Now its worse than ever.

[AllaN01Bear]

22. most insurace cos are legeal scams .

[TNNurse]

24. I am 76,

I recently spent MONTHS getting approval for CPAP for documented sleep apnea and for a new compression machine for the lymphedema in my arm from cancer treatment. The previous machine I had used for 12 years, I just wanted a replacement part but it was obsolete. When I mean months, I mean 6 months for each of them.

For the record, just like diabetes, sleep apnea and lymphedema do not go away.

[hunter]

25. The people who answer the phone have no authority to fix the problem...

... and act as if they'll be fired if they transfer the call to someone who is.

I haven't been hung up on yet, but I do get transferred to numbers that never answer or get sent back to the original menu. I've wasted countless hours of my life dealing with this kind of crap.

AI is only going to make it worse. It's being used by companies that only want to pretend they have customer service but don't actually want to provide any customer service.

It's infuriating. Sometimes I have better luck calling my health care provider. They have people who deal with this kind of crap every day. Of course that's just another reason health care costs are so high in the U.S.A..

I hope you find a solution to this.

[Ms. Toad]

27. Medicare?

If so, it goes through Part B (not pharmacy), and it does require pre authorization - but it's not a big deal. Essentially as long as you're on insulin and have seen a doctor in the last 6 months you're fine.

In our case, it was the doctor who screwed up (his administration is falling apart at the seams), and the pharmacy (which tried to run it through the prescription coverage). It took a month to straighten out - and a second free monitor from the doctors office to keep us going until they uncrossed their wires.

[LuckyCharms]

33. No I'm not on Medicare yet despite my age...

I don't get it yet because I am covered under my wife's insurance through her employer. BCBS.

What happened was this...

With Dexcom G6, you have 3 components:

Sensors (they have to be replaced every 10 days)

Transmitter (replaced every 90 days)

Receiver (replaced every year or so I think)

My transmitter is due to expire soon, so I phoned in a refill to the pharmacy. Insurance refused to pay for it, saying that I needed pre-authorization.

The rep told me that they would not approve the transmitter because I just got it filled on February 1. I said THAT WAS THE SENSORS THAT I HAD FILLED, NOT THE TRANSMITTER!

Then she hung up on me.

So that's what I am trying to sort out.

[Ms. Toad]

39. Interesting.

My spouse uses Libre3+ It only has two components - sensor+transmitter combined (replaced every 14 days), receiver (replaced every 5 years - but we're using the phone app).

It was a nightmare getting it set up because of the doctor's office screw up, the pharmacy screw-up, and the (almost) DME provider screw up (that one would have cost us $1800).

I hate dealing with insurance. I'm good at it, but it doesn't make it fun. I once spent 200 hours fighting them over what ultimately was a $100 bill. I won, as I have every battle I've chosen to fight. (That one was based on principle - and trying to fix the system for others who could easily be caught in the same tangled web I ended up in.)

Good Luck. Do make sure that the pharmacy is billing under DME. That was the pharmacy screw-up in our case - they always default to prescription coverage for diabetes supplies, and don't even bother to try the medical. It is usually covered under both, and nearly always cheaper (in many instances free) as DME. The Part D coverage declined the CGM - under Medicare (unlike ever other plan I've been on) it is exclusively covered under the medical portion of the plan.

How is the reliability of the Dexcom system? We've had to replace 3 sensors (out of 6) early because of sensor failure. If this keeps up, I'm going to push my spouse to consider a different system. Abbott is currently under an FDA warning letter for failure to perform quality assurance checks at the proper times to ensure quality.

ETA: My spouse was on my insurance until she hit 70 and I retired.

[LuckyCharms]

43. I'm on the Dexcom G6, which is being phased out on 7/1/26.

So I will have to switch to the G7, which is going to be a learning experience, and most likely, an insurance nightmare that I am not looking forward to.

If I understand it right, the G7 has the transmitter built right into the sensor, which is now changed every 15 days, instead of every 10.

The G6 works pretty well for me, except sometimes when changing the sensor, I hit a capillary and the sensor fills with blood, rendering it useless.

When that happens, I call Dexcom, and they are good about sending you a replacement sensor for free.

Sometimes a new sensor will be wonky for a few hours, and you have to finger prick to get the right reading, and then calibrate the sensor to the finger prick reading.

Good luck to you as well, and to your spouse too.

[PatrickforB]

28. This is one of the plans for bringing in AI in such a big way. The evil greed lizards of Wall Street and

the insurance 'industry' want to make it impossible to get to any living breathing person by putting up all kinds of AI prompts that have you screaming Agent! Agent! Agent!

Soon it will be all AI and every word you utter will be recorded and analyzed by the Surveillance State Elon, Theil, Zuck, Bezos and the rest of the evil dirtbags are trying to set up to enable our transition from a republic to a dictatorship.

That is what this IS and it is fucking evil, evil, evil, evil. Every single one of these insurance and for-profit healthcare and pharma fucks need to be tried for crimes agains fucking humanity, and all the nazi dirtbags in the Republican and Libertarian parties need to be held accountable for their crimes against humanity and now their war crimes.

They are riding high now, but hubris comes before the fall, and my prayer is that fall be long, hard and permanent.

You know what we need after we primary out all incumbents? We need to rebuild the whole fucking thing. Get rid of Wall Street altogether and start really building community. And I'm talking about supportive culture, an actual culture. Because right now this country does not have a culture. Only an economy.

And I'm fucking sick of it. These are evil parasites and we need to flush them out. All of them. The root of all evil is love of money (greed, envy, lust, gluttony, pride, wrath and distraction) and we need to reinstate a moral compass and I'm not talking about some religious dogma.

I'm talking about loving each other, living in harmony with God, each other and the sacred earth, and treating other people the way we want to be treated.

[ECL213]

29. But, but, but...

We have the best healthcare system in the world, and you can choose your own doctor, right? RIGHT???

Sure, the cost for the same exact coverage and the deductibles go up every single year, but at least I've been able to choose my own doctor at least three times in the last three years. Three different doctors, mind you, because they keep switching practices, but by God I've been able to pick them, and it only takes a few months to get established with a new one, and I always have the option to go to Urgent Care or a Minute Clinic in between doctors. So what if I get bills for hundreds of dollars after I get a scope shoved up my ass or down my throat, and then I pay it, and then a few months later I get a check from the providers because Insurance finally paid the same bill. Who cares if I have to go to separate locations to have blood drawn because my doctor doesn't have an on-site phlebotomist anymore. I have however much time it takes to be able to take advantage of the greatest healthcare system in the world!

Motherfuckers.

[Goonch]

31. ;-{).....

[Cirsium]

34. Hours spent today here

Simple straightforward claim mysteriously rejected, no one can tell us why.

[LuckyCharms]

38. Christ. Amazing, isn't it?

[Cirsium]

45. A Nightmare

It is a nightmare for those with good plans and in relatively good health, who have the time and resources to endlessly battle with the system.

[1WorldHope]

35. My daughter's husband is type 1 and they are having the exact same experience.

This guy has had diabetes since childhood. He never had ins before ACA. He is so libertarian I made him cry by arguing with him that it could help him. He finally gets decent health care gets to try the new pumps etc. realizes how helpful it is and Bam here comes Trump. Half the time the monitors don't work or the pump doesn't work. It's a freaking nightmare. I understand what you are going through and it is total bs. 🤬

[LuckyCharms]

37. Tell your husband to stay strong, and you too. I am on MDI (multiple daily injections)...

During my recent visit with my endo, she was trying to get me to go on the pump.

I said no, and she asked why.

I said that it is really true that age you age, technology gets harder to deal with, and I'd rather live and die by my own hand rather than dying in my sleep because my pump failed.

With MDI, I can dial up the units on the pen, and push the plunger with my very own thumb without having to worry about a pump failing.

[1WorldHope]

40. When my daughter met him he was still using viles to draw his insulin.

He is a hard worker, climbs trees and cuts them down. So his blood sugar was almost always out of wack. When his blood sugar is low, like every morning, he is a raging asshole. That imbalance has been really hard on my daughter and their 2 girls. It's an awful disease. Hang in there, nothing is right or fair right now. Apparently the diabetes federations are no help at all. Congress people always say to call them, even if they are Repubs, have you ever tried that?

[Dorian Gray]

36. I am really sorry

you and your health needs are caught up in the frustrating insurance cycle. I know many people who this has happened to. Including insurance refusing to pay for cancerous tumor removal.... the day before the scheduled surgery.

This is their MO. Bottom line more important than people. it's an untenable system, and it bankrupts a lot of people.

I hope your wife has better luck on the phone.

Best wishes to you and here's too good health outcomes!