Managing a chronic illness demands immense patience, adaptability, and determination. I have a unique viewpoint on this topic. Not only do I navigate life as a type 1 diabetic, but I also work in healthcare.
When you’re first diagnosed with type 1 diabetes, you’re not informed that alongside the endless finger pricks, carb counting, and injections, you’ll also need to maneuver through the healthcare system to ensure your essential medications are covered. As a healthcare provider, I encounter prior authorizations daily. This process requires insurance companies to demand that providers submit paperwork explaining why a specific medication or treatment is necessary for the patient instead of the insurer’s preferred or covered option.
Perhaps due to my background, I vigorously advocate for my patients to have their medications covered. Sometimes I succeed, but unfortunately, there are times when I do not. As a type 1 diabetic, I was introduced to the concept of prior authorization long before I learned to tie my shoes—kidding, but not entirely.
For instance, each year, I must obtain prior approvals for all my medications—essentially jumping through hoops. This tedious process is anything but quick. I’ve spent countless hours on the phone with insurance companies since my diagnosis. This year, they refused to cover my life-sustaining insulin pump, which I’ve relied on for over five years. The lengthy 9-page letter sent to my endocrinologist denied coverage for my medical device and suggested a substitute pump designed for type 2 diabetes management—despite my never having been diagnosed with type 2 diabetes. How is this a reasonable alternative?
I often ponder what would happen if I lacked my medical knowledge. Would I know to contest these decisions to secure my medications? Would an average person understand that the proposed option is entirely unsuitable for their condition? What recourse do those without a medical background have in these situations? Do they simply comply with what the insurance plan recommends, ignoring their healthcare provider’s advice? Who gave insurance companies the authority to override what I believe is best for my health? Why do they presume to understand my illness better than my endocrinologist, who possesses years of expertise in her field?
Don’t misunderstand me; I appreciate having health insurance. Without it, a 25-day supply of insulin would cost me $349.48. That could easily be a topic for another blog post. (Stay tuned for that). But how can we progress and reform this broken system? Not only does this dynamic complicate my role as a healthcare provider, but it also leads to burnout and frustration for individuals like me managing a chronic illness.
There have been moments, particularly after lengthy holds with insurance representatives, when I’ve exclaimed, “That’s it, I’m done with being a diabetic!” The mental fatigue I experience is not solely due to the disease itself, which is exhausting enough. The countless hours spent wrestling with insurance companies elevate the stress to another level. Sometimes, customer service agents bear the brunt of my frustration, though it’s misdirected—they’re just doing their jobs, often reading from a script. They may not fully grasp my condition or why I require specific medications.
While I don’t have a clear solution for these challenges, I do know one thing: I will continue to advocate relentlessly for my patients and myself until a cure for type 1 diabetes is found.
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- Managing type 1 diabetes
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In summary, living with a chronic illness like type 1 diabetes involves not only managing health but also navigating a complex healthcare system that often puts patients at odds with insurance companies. The ongoing struggle for medication approval can be exhausting and frustrating, yet it highlights the importance of advocacy and perseverance in the face of systemic challenges.
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