We had no choice of insurers when my husband started his new job. It was Cigna or go pound sand. So we have Cigna with a high deductible plan.
I spent $2,180 for insulin pump supplies and CGMs for Maggie's continuing care (eleven years and counting) in February assuming that it was more than halfway to the deductible. I now doubt whether the supply company checked with Cigna for prior authorization before shipping the supplies, but I know I DID provide the insurance information. Cigna still hasn't finished processing the claim. I don't know whether they are ultimately going to cover it and will apply the $2,180 toward the $4,000 deductible. I'm about to need to order more, still not knowing whether they will cover it. If they do, this would put us over the deductible and mean that we would be done spending money on Maggie's T1D care for the year. Or maybe we are just on the hook for it because they just don't consider that the gold standard of type 1 diabetes care that she has been getting for over a decade through two different insurers and multiple policies is "medically necessary." Every trial done shows the very DUH result that "sensor-augmented pump therapy" is the best way to control blood sugar in type 1 diabetes and to minimize both short and long term complications. That sounds pretty fucking medically necessary to me, but what do I know? I'm not a claims specialist at an insurance company.
It is now been a full two months since our pharmacist told me that Cigna will not cover the brand of insulin that the previous TWO insurers approved without hesitation. I asked the endo office if Maggie would really have to switch to less effective insulin, and they said they would request prior authorization. I'm still waiting TWO MONTHS LATER, and we are down to the last of the kind of insulin that both CDPHP and BCBS paid for without question or fuss.
It is INSANE that an insurer can decide that they will not pay for PERFECTLY FUCKING STANDARD treatment that has been working brilliantly for a decade.
I have been pinging the endo every week or so and the latest was that Cigna says have no record of Maggie being insured. Weird because she has an online account with claims that are being processed, and the pharmacy told me that Cigna would pay for Humalog rather than Fiasp, so THEY know she's insured.
We happened to have a lot of insulin backed up, but it's been two fucking months. We have about three weeks before she runs out of insulin and becomes gravely ill. There is URGENCY here, folks. You'd think healthcare people, both doctor's office and insurer, would know that.
I'm sure that a hospital will view it as medically necessary to admit her when she goes into DKA. Maybe Cigna won't. Who knows?
