I'm Managing A Chronic Disease — And I'm At The Mercy Of Health Insurance Companies

by Mandi Franklin
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Managing a chronic disease requires a lot of patience, flexibility, and persistence.

I have an interesting perspective on the matter. Not only am I a type 1 diabetic, but I’m also a healthcare provider.

When you are first diagnosed with type 1 diabetes, no one tells you that on top of the countless finger pricks, carbohydrate counting, and injections, you’ll also have to deal with navigating through the healthcare system to get your life-saving medications covered.

As a healthcare professional, I deal with prior authorizations daily. Prior authorization is when an insurance company requires that a provider fill out paperwork detailing why this particular medication or treatment is necessary and appropriate for the patient versus the insurer’s preferred or covered option.

Perhaps because of my personal history, I fight hard to get medications covered for my patients. Sometimes it works, and sadly sometimes it does not.

As a type 1 diabetic, I learned what a prior authorization was before I could tie my shoes. (Kidding. Sort of).

Let me give you a personal example: Every year, I need to get prior approvals for all of my medications – also known as jumping through hoops. This process is anything but quick. I have spent eons on the phone with insurance companies since my diagnosis. This year, they didn’t want to cover my life-sustaining insulin pump, which I have been on for over five years. The 9-page wordy letter sent to my endocrinologist stated that they denied coverage for my medical device and suggested that my doctor prescribe a substitute. Their preferred choice was a pump used for the management of type 2 diabetes. I have never had a diagnosis of type 2 diabetes. So, how is this a reasonable alternative?

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I sometimes wonder what would happen if I did not have my knowledge and skill set. Would I even know to push back to get the correct medications covered?

Would a layperson know that this proposed option is not even suitable for his or her disease?

What does someone without a medical background do in these situations? Roll over and use what is urged by the insurance plan, disregarding what his or her healthcare provider suggested?

Who gave the insurance company the right to override what I think is best for my patient?

Why do they feel they know better about my disease than my endocrinologist, who has years of experience and is an expert in her field?

Don’t get me wrong; I am grateful for health insurance. Without it, a 25 day supply of insulin would cost me $349.48. That is a blog post in itself. (Coming soon to a publication near you).

But how can we move forward and change this broken system? Not only does it make my job as a healthcare provider demanding, but it causes burnout and exasperation for people like myself who are living with a chronic illness.

There have been times, specifically after being on hold with the insurance company, where I have thrown my hands in the air and said, “that’s it, I quit being a diabetic.”

The mental exhaustion is not from the disease itself, which is tiring enough. But the countless hours spent wrestling with the insurance companies take it to another level. Sometimes the customer service agents get the brunt of my anger, but it’s misguided. They’re just doing their jobs and simply reading from a script. They may not know much about my disease or why I require specific medications and treatments instead of others.

I don’t know what the long-term answer or solution is.

I do know one thing, however.

I will continue to fight tirelessly for my patients and myself until there is a cure for type 1 diabetes.