After reading a post on the DOC about frustrations related to the cost of test strips and insurance coverage, I asked my friend Susan Elms to provide a guest blog about this topic. Susan works at Diabetes Specialty Center and has lots of experience working with insurance benefits and test strips. While this won’t solve all frustrations related to the cost of test strips, we hope this will provide tips on working with your insurance carrier, pharmacy, and durable medical equipment provider to obtain the most reasonably priced strips possible.
Navigating insurance benefits can be daunting to say the least. Here are a few things that might be helpful to know. Most people with insurance have a pharmacy benefit and a medical benefit. It is important to check the pharmacy and medical benefits so that the plan can be utilized appropriately for each person. Not all places process the medical benefit along with the pharmacy benefit. However, it could be worthwhile to find a place that does process both to see what is available to you. Sometimes going through one benefit over the other can save considerable amounts of money over the course of the month and year. When it comes to diabetes test strips and supplies, they can often be covered under either benefit, but people do not always realize this is an option. Also, going through the medical benefit can sometimes assist in keeping those with Medicare out of the doughnut hole. Checking both benefits, to see what is available, empowers you to make an informed decision.
Costs of testing supplies can vary due to the insurance coverage, and where you are getting your supplies. Companies negotiate with insurance plans on their contracts and what is covered. Through some companies you might not have a co-payment on testing supplies, while with others you will. This is due to the contracts each company has negotiated.
Insurance companies usually have a preferred meter. If the meter you are using is not the preferred meter of the insurance company, test strip costs are higher. Through some insurance plans going through the medical benefit allows flexibility in which meter is used. It does this by taking the preferred meter status out of the question since that applies on the pharmacy benefit side. This is not always an option, but it does not hurt to check.
Being proactive about the benefits you have available is your right. Also, it does not hurt to shop around to see options of services and costs that are available with different companies. A gentleman we work with had tertiary (triple) insurance coverage, and was still paying a twenty dollar co-payment for supplies each month. After doing a benefit analysis, he was thrilled to find out he would no longer have a co-payment for supplies. Ask your pharmacist, mail-order company, or diabetes supplier for a benefit analysis on your medical and pharmacy benefits. Checking this each year can be beneficial as contracts can, and do, change for supplies.