Selecting New Insurance

Open enrollment can be a confusing time. We recently had a rate increase with our insurance so I made my own spreadsheet of insurance choices. A few others were in the same boat so I shared this with them and now you. My daughter had the Blue Options 1424P plan and now has the Blue Select 1535P plan. This is how "I" compared.

My breakdown is as follows: (*See Disclaimer at the Bottom of Page) 

Woah, craziness huh?!  Here is the key to this:  The yellow and green sections at the top are basically the same plans, except Blue Select is a different network than Blue Options. Blue Select is a smaller network and saves big on monthly premiums. (The blue highlighted has a Blue Options comparative plan but wasn't one I was focusing on). I found that my daughter's pediatrician, pediatric endocrinologist, CGM supplier, and local children's hospital were all now providers for the Blue Select network, so it no longer made sense to continue paying higher premiums for the Blue Options network. 

What does all this mean?!?

Terminology Basics:

• Deductible is the amount of money certain plans charge out of pocket before coverage starts on certain benefits. If a family deductible is indicated, this means that if 2 people met their family deductible and the third person on the same plan went to use their benefits, they would not have a deductible because the plan capped it (example $800/$1600. Person 1: $800; Person 2: $800. Equals $1,600, so if Person 3 had to use benefits requiring a deductible, it would show as already having met the family deductible and there would not be a deductible charge for that Person 3. However, co-insurance may still apply if Family Out of Pocket Maximums were not yet met.)
• Co-insurance is the percentage of the negotiated/adjusted bill that you'd be responsible for (up to your out of pocket maximum). 
• Out of pocket maximum individual: The most that (utilizing in-network providers, brands, etc) that you would pay out of pocket, not including yearly premiums. This is a single person.
• Out of pocket maximum family: If multiple people were on the same plan and each had a BAD year, this is the most that family would be paying out of pocket, besides premiums. 
• The "P" at the end of these plans stands for Pediatric, which means that these plans have pediatric dental and vision included for $0 for most items. (All of these particular plans offer most items at $0 so I did not do a complete breakdown of benefits, but these include glasses, exams, cleanings, fillings, dental x-rays, etc.)
• All information was gathered from the insurance website. (In this case bcbsfl.com)

I posted a few icons on the side of the breakdown picture: 

• Green key: 1st visit is $X; 2+ = any subsequent visits are $X
• Blue crosshairs: There is a maximum on some of the plans for 3 days. So there is a co-pay of $X per day, up to 3 days worth of co-pays, after which there are no additional co-pays per day. 
• Purple arrow: The DME category is extremely important for type 1 diabetics who intend to receive any sort of pump or CGM equipment while on the plan. Always review this area for coverage details prior to selecting a plan. These plans all show $0, which mean that a member would receive a pump, pump supplies, CGM, and CGM supplies for $0. No deductibles, co-pays, or co-insurance. 
• Yellow star: The * next to $20 indicates that this plan has a Condition Care RX program, which gives reduced co-pays on medications for certain chronic conditions, including diabetes. Meaning that instead of the normal $40 co-pay for preferred brand RX, preferred brand diabetes medications would only be $20. You'll also notice that there is a 3 month mail order in place for diabetes RX's as well, for a reduced co-pay of $38 (3 months), which can save you $22 per 3 months per RX. *UPDATE 2/29/16: I ordered under the 1535P and found that this plan does not offer the Condition Care RX program anymore like 1424P does. The copays are $50 per 3 months (tested on insulin and strips) but I found that it went down to $36 for lancets. So a bit more for a few plans than anticipated but nothing that would sway choices in other directions. As always, verify coverage prior to enrolling in any plan. Condition Care RX is something not always advertised so apparently I missed that it was not the same as before. My apologies!

Scenarios: (Yes, I was thorough and had even more non-diabetic scenarios but limited it here for target audience purposes). Scenarios are how you get plans to make sense. You can look at a few plans and see a scary 40% co-insurance, but how often would that even apply?  Maybe it's a difference between the higher deductible plan with lower premiums vs. a higher premium plan with lower deductibles. Scenarios are the best way to make that decision of risk vs. benefit for what you anticipate your needs to be in any given year, along with a few years of increased expenses. 



Scenario 2 (really is first one shown here, sorry!):  I want to point out that these are estimated costs and number of visits, everyone would be different. Locations, hospitals, negotiated rates, premiums, everything VARIES per person. This was for MY daughter but is the guideline of how to create your own basic spreadsheets. 

• Yearly: Monthly premiums times 12 months. Remember that these do not count towards out of pocket maximums. 
• Deducible/Coinsurance/Out of Pocket Max's: Recap of the plan benefits
• PCP: Primary Care Physician. This scenario estimates 2 sick-day (not preventative) visits to PCP. 
• Specialist: assumes 6 visits to the specialist (IE: endocrinologist, increased from normal year due to DKA follow-ups etc). 
• Labs: Assumes yearly maintenance labs were completed at an independent participating lab (such as Labcorp/Quest). 
• Inpt Hospital/Physician: 2 days spent in-patient hospital for a negotiated rate of $20,000. (This is quite high but covers nationwide fluctuations). 
• DME: Assumes Dexcom CGM Kit (1 receiver; 2 transmitters) and CGM supplies/ Pump supplies for 12 months. If getting a new pump, would still have been covered for $0.
• RX's: 12 months of Insulin (this is assuming pump, which is bolus only); Strips; and Lancets are mail order under this plans Condition Care RX program, which means that 3 months is discounted to $38. So for a year's worth, it would be refilled 4x at $38 per script, times those 3 scripts. Non-pumpers would have their basal insulin in addition to this. Glucagon: I did an assumption of 2 per year, filled at retail pharmacy but still under the Condition Care RX program for a discounted co-pay (but didn't add in the second refill co-pay, this is a mistake but for the time and effort of making this picture wasn't worth fixing it.)

I then compared each category involved and the assumptions made. I will breakdown the first two plans for comparison. 

Blue Select 1535P: Yearly premiums are $2,904. Visiting the PCP twice for non-preventative visits are a $25 co-pay each time, so $50 total. Visiting the specialist 6 times means a $60 co-pay each time, for a total of $360. This plan has an in-patient hospital co-pay of $600 per day (up to 3 days max), which means a 2 day hospital stay would be $1,200. Preferred RX for glucagon is a $20 co-pay per fill (yes, I miscalculated here, add $20 or assume only 1 glucagon was filled that year). Filled 3 scripts via mail order pharmacy 4 times that year, for a total of $456. All CGM and pump supplies are covered for $0. The out of pocket maximum was not met. This plan meant an estimated cost of $5,010 (or $5,030 with second glucagon). 

Blue Select 1451P: Yearly premiums are $3,252. Visiting the PCP twice for non-preventative visits are a $0 co-pay each time, because the first 3 sick visits to PCP under this plan are no co-pay. This plan has an in-patient hospital deductible of $800 plus 10% coinsurance. Assuming the negotiated rate of the stay is $20,000, that means: $20,000 minus $800 is $19,200. $19,200 times 10% is $1,920. Add back in the $800, for a total hospital bill of $2,720. However, the out of pocket maximum is only $2,500 so this is the maximum you'd be spending out of pocket (assuming you were using in-network everything).  (Visiting the specialist 6 times means a $20 co-pay each time, for a total of $120. Preferred RX for glucagon is a $20 co-pay per fill (yes, I miscalculated here, but assume only 1 glucagon was filled that year). Filled 3 scripts via mail order pharmacy 4 times that year, for a total of $456. BUT ---there are actually no co-pays for any of these because out of pocket maximum was met with hospitalization. This assumes it occurred before any of these co-pays were paid, otherwise the overall idea is the same but the payments would be spread out through the specialist/pharmacy etc and the hospital would just collect less from you) All CGM and pump supplies are covered for $0. This plan meant an estimated cost of $5,752. 

The Blue Select 1457P plan yearly cost in this scenario estimated $4,732; Blue Options 1505P estimated at $5,938; and Blue Options 1424P estimated at $5,860. The winner here is the Blue Select 1457P plan when basing the plan benefits on a scenario such as this.

However, you need to account for if this is the norm vs. an abnormal year. Scenario 3 (really the second shown) shows a typical year with normal endocrinology visits and supplies, without hospitalization. For a normal, healthy year, the Blue Select 1535P plan was the winner. 

Because my daughter was switching from the Blue Options 1424P plan to the Blue Select 1535P plan, we saved an estimated $1,460 PER year. By not being complacent and accepting the rate increase and staying with the same 1424P plan, we save $6,690 in a scenario 5 year period (assuming 1 year of hospitalization scenario and 4 maintenance years). We save even more if she remains healthy during those same 5 years. 

The difference between the hospital DKA scenario and the normal year scenario for the two "winners" was only around $275 (Plans 1535P vs 1457P). So for our family, in risk analysis, it was worth the gamble of $275 in a hospital scenario (non-probable) in order to automatically save $330 per year by choosing the 1535P plan over the 1457P plan. In a 5 year period, if we "win" $330 (assuming stagnate rates etc) in 4 of the 5 years, we still come out ahead over a thousand dollars over that period, just by choosing the plan that makes more sense for us and previous health indications.  


This guide is helpful if you are needing help deciding between group insurance plans, individual plans, COBRA insurance vs. individual plans, or when there are rate increases, benefit changes, employer contribution changes, etc. It is geared towards a type 1 diabetic, but the principles can be used by non-type 1's as well. 


*Disclaimers: I am not an insurance agent or authorized representative of any insurance company, etc. All information should be verified prior to enrolling in any health insurance. Prices are based on a child-only individual policy without subsidies for Florida Blue for a four year old child with information found on bcbsfl.com. Any mistakes are my own.  A child-only policy typically is an individual plan that is found directly with the insurance provider and may not qualify for subsidies. These are not government plans such as Medicaid/Medicare and rates can change at any time and all benefits are subject to the written terms of the plan, including limitations and exclusions. Increased usage of the plans may result in additional charges up to the out of pocket maximums. Not all plans found in the United States offer prescription co-pays under their maximum out of pocket umbrella and you may need to calculate them above and beyond any out of pocket maximums. This is especially important if you are on any specialty drugs (such as for cancer, HIV, hepatitis, etc.) Your personal insurance agent or HR representative should be able to provide more details about your plan options. Not all plans cover pumps or CGM's (and supplies) under DME or at all, as they may be subject to limitations, exclusions, or pharmacy benefits. Check all benefits carefully prior to selecting/enrolling. 

Initial Diagnosis Must Haves

Someone we know of recently had their son diagnosed. I was thinking about what I would have like to have known would be needed once we arrived home. I slowly collected items over the first few months but it was all gathered from different ideas scattered all over the internet, as well as books I was reading in between my fuzzy eyed 2am blood glucose checks. So I thought I’d be super convenient and write a Best Of list for those parents who are facing the new reality of the diabetes life.

1. Sharps container (We get ours free at our local fire/health departments). I   also purchased a small one for the car.

2. Fast acting glucose: Capri Suns; Apple Juice boxes; Jelly Beans (1g per); Level Glucose gel packs; QuickSticks (Walgreens), & 15g Snacks (such as protein bars).

3. Supply on-the-go bag – We received a free one but quickly opted to get a makeup bag that had separated compartments.

4. Supply organizer for home counter– It’s like Caboodles makeup counter organizers were made for D supplies. (see other post where I outlined what we keep in ours)

5. Supply organizer for cabinet – I bought a plastic bin that had three layers. I stored extra syringes, lancets, meter control solution, extra meters, meter instruction manuals, extra alcohol swabs. (In the beginning before your stash grows, you will likely only need a bin. Later it’s a bin plus an entire cabinet in your kitchen)

6. D care items: Alcohol prep pads; syringes; insulin, testing strips, glucose meter, lancing device/lancets, ketone strips.
        a.  I am a big fan of Accucheck FastClix lancets. They come in a barrel so you never see the lancet. They come with the Accucheck Nano meter (which we received free from Endo).
        b.  We also like the Contour Next USB meter/Strips. The accuracy is among the best, the USB is nice to plug in, and it is conveniently on our insurance’s preferred list.

7. Other D care items we received/purchased: CalorieKing carb book (buy an extra for the car!); Precision Xtra Blood Ketone Meter/Strips (So you know exactly what the level of ketones are; especially helpful if your child isn’t potty trained); an insulin koozy which protects the insulin bottle if you drop it because it smells bad and is a very expensive mistake versus a $7 vial protector. (Amazon)

8. The Pink Panther book is great, but some places only give the smaller edition. We were lucky enough to also receive the expanded edition from a relative and highly recommend it. I would save the abbreviated version for other care providers who will need to learn a bit about diabetes but not all-day, every-day care. We also supplemented with Think Like a Pancreas; Guide to Accurate Carb Counting (both) by Gary Scheiner, CDE; Kids First, Diabetes Second by Leighann Calentine.

9. A decent digital scale. Soon you will be learning to carb count and until you are able to eyeball serving sizes in your sleep, you will need a scale with at least the tare feature, as well as ability to measure grams and ounces.

10. Lo/No Carb drinks. Your kiddo will suddenly have to account for every carbohydrate gram going into their mouth. Those previous cokes, Capri suns, and orange juices will have to wait for treatment of lows. The new game in town is lo/no carb drinks. Our favorites are Minute Maid’s Just 10 and Fruit Falls juice packs, Aquafina FlavorSplash, VitaminWater Zero, Powerade Zero, Crystal Light (powders or liquid), Mio, ICE flavored water, V8 Light Splash. You can of course get diet sodas, teas, etc that are low in carbs.

11. Carb log book. Personally, I hated the ones that came with the meters. I bought a spiral notebook style daily calendar. It has a lot more room to write. After a bit you learn that it’s essentially TIME; BG #; CARB #, INSULIN UNITS. You can add in variables next to it if you want, such as exercise, foods, etc.

12. A 3 ring binder (2" or larger) with clear page protectors. I made a cute one that I keep all the handouts from the endo in, such as carb counting basics, ketone info, daily logs they require before visits, illness guide, symptoms of high/low BG, etc.

Does this seem like a lot? No, it's really not too bad! Just a trip to local pharmacy (for D care supplies, your MUST must have), a Walmart/Target, and a foray on Amazon.

The Dreaded Dexcom Rash

     If you’ve read my previous posts, you already are getting a sense that I LOVE our Dexcom. It is literally a life-saver and we are way too paranoid to not know what our daughter’s blood glucose is doing at any given time. (The saddest country song has it more together than my daughter’s blood glucose stability).  So suffice to say, about a month ago we pulled off her Dexcom and noticed it was really bumpy/scaly underneath. I  thought she might have a bit of dermatitis from the tape, so I scrubbed it extra in the shower and forgot about it…..until the next site change. Her other arm under the tape looked like a chemical burn. It was weeping, raw, and angry. We have always covered the Dexcom tape with a layer of Opsite Flexifix and the wound was only under the area of the Dexcom tape but not under the Opsite which extends way beyond the perimeter. (We live in FL, our daughter is very active, and she’s a sweat-er so we've done Opsite each time around the borders). We went back to the arm that originally had the bumps (which had turned a bit pink after scrubbing) but a week later we pulled it off and found another weeping, chemical burn-looking wound that was even worse than the first one. I try to take most things in stride but all I could think about was my daughter as a teenager and young woman having scars on her body from years of adhesive allergies. It made me determined to find a solution.   (BTW - in case you are curious, it took about 3 weeks for the burn-like wounds to heal and the skin is still a bit rough in the area. The worst arm looks like it has a white coloration instead of pink/red. If you've ever worked with burn patients or have been burned yourself, you know that burns start red/pink and fade to white as they heal. It took a couple of months for the white to go away.)

About 1 week after "burn" wound from Dexcom adhesive

• So we tried her stomach next along with IV Prep underneath but she is very lean in the area and the sensor failed within 30 minutes. We googled Dexcom rash and Holy Toledo(!), the images looked identical.
• Next we tried her leg with the Dexcom tape placed on top of two layers of Opsite with a hole cut in it, along with the Dexcom tape trimmed down, then covered with another two layers of Opsite (with a hole for the transmitter). We also stopped cleansing with an alcohol wipe and started soap and water to reduce dryness. When it came off a week later, it looked better. Slightly purple underneath the square of the Dexcom tape (the new shape we had trimmed it to). However, when I attempted to clean it with a washcloth, the skin sloughed off to reveal pink underneath which meant she was still reacting to it.
• Next up was a double layer of Opsite underneath with no hole cut out, I punched through the tape directly with the Dexcom sensor so that the adhesive has even less opportunity to come into contact with her skin. Again I trimmed the Dexcom tape and sandwiched it underneath another two layers of Opsite. It wasn’t a complete success because the site turned pink underneath the next day. We decided to stop it on day 7 from now on.

    Somewhere in the deep crevices of internet advice I stumbled upon one or two recommending a blast from an asthma inhaler before applying the adhesive. The theory is that the corticosteroid of an asthma inhaler inhibits the allergic reaction of the tape. Creams beforehand would not allow the tape to stick at all, so you have to think outside the box. Hence, an aerosol format. Makes sense to me! So I brought it up while getting her flu shot from her pediatrician and he sent me home with a sample. Yippee! I love not fighting with Dr.’s about weird remedies like that. I also had heard rave reviews about the Johnson & Johnson tough pads working as a barrier underneath.

So after months of doing the above regiment,  we added a barrier wipe.  We also rotate between both arms, as well as 2 areas on both legs. Belly is still out of the question due to her being too lean and the amount of ???.

We currently have the following system and takes an additional 5-10 minutes:
- Clean w/soap & water
- Spray asthma inhaler Qvar 40 (or Flonase, a nasal allergy spray recommended by her Endo)
- Doughnut swipe with IV Prep (Minus "doughnut hole" where sensor wire punctures through skin)
- J&J Tough Pad
- Dexcom (with adhesive trimmed to fit onto Tough Pad without getting near edges)
- Wipe edges of both Dexcom G4 tape and Tough pad down with more IV Prep (to aid in sticking)
- Strips of Opsite flexifix tape down the edges of Dexcom/tough pad.
- One more strip that I place on the very edge of Dexcom transmitter (fat end only). I overlap a bit on the transmitter, the plastic casing, and the rest is on the adhesive. I do this along the back end then fold the opsite towards the body of the Dexcom (like a fat "U" shape) so that there is no gap between opsite and the transmitter.
-(Extra summertime fun requires vetwrap to help prevent tape from peeling. If you need help keeping the vetwrap on, make sure you tighten enough that you can fit a finger underneath the stretch but no more to where you are cutting off circulation or causing a compression low. Then secure the ends with a butterfly bandage.)

To remove the system on day 7, we use Unisolve to make sure all the adhesive is wiped off, then we wash the Unisolve off.  Apply a good moisturizer.

Updated 7/2015:
The moral of this update is to not give up on the CGM. Because so far so good! We tend to rotate between 4-6 separate areas so that we do not reuse a site more than every 4-6 weeks or so. Compared to the previous chemical burn reaction though, we'll take a bit of pink bumps for those few times it gets a bit more irritated (and usually only notice a reaction to the Opsite Flexifix IF we have to re-do the tape at any point during the 7 days. If we don't add the IV prep/Qvar step underneath the Opsite, it seems like she turns red underneath the Opsite for a day with itching.) But overall, we have been using this system for about a year and a half now and found that it works as the only solution that will allow us to continue using the CGM. We rarely, rarely have failed sensors even with the IV prep and Tough Pad underneath. (I mean like maybe 1 per 6 months, if that?). And even better, Flonase is now available OTC so if you are unable to get the Qvar 40 from your doctor, just try the Flonase. It takes a lot longer to dry since it is liquid, but still worth it!

Update 7/17: We have decided to replace the Opsite Flexifix with the new Stayput Medical patches. We just weren't happy with the slight irritation left over from the Opsite and always had to ensure the edges weren't peeling up. We tested the Stayput patches for both our Omnipod and Dexcom sites and she hasn't reacted at ALL, which is fantastic. Also it has helped with the water issues we were having, we'd constantly worry about her in the pool or bathtub and if the Opsite would hold. The Stayput really do stay put, so in sweaty Florida weather, it has been a relief to not worry about an early site change from adhesive issues. They seem to be a bit bigger than some competing patches, which the smaller sizes and shapes of competitors like Grif Grips didn't seem to cover much skin outside the device adhesive and thus deterred us from bothering with them. So yay for something that works and isn't an allergen! 

Organization is Key

 

One of the first things to do when getting started with a new D diagnosis is get organized. I started off with the travel pack they gave us at the Endocrinologist office, but our supplies rapidly started outgrowing it, not to mention how inconvenient some of those pockets are at 2am. So I headed out and picked up a few things and ordered online a TON of stuff. 

The first and BEST thing I could've initially purchased is the clear acrylic organizer by Caboodles. There are a bunch of different ones by that company, as well as I'm sure competitors, but this one just fits our D stuff so well. This one was about $16 at Target in the Beauty/Health section.


In that organizer you will find: 

• Pen needles & 3/10 syringes.
• Glucose meter, strips, and Calorie King nutritional book.
• Alcohol swabs, box of FastClix lancets, box of Precision Xtra blood ketone strips and meter.
• In the individual cubbies are: Lantus (in a green koozie), Humalog Luxura pen; FastClix Lancing device; Sharpie; Humalog bottle koozie; Ketostix; glucose meter control solution. Not exactly lipsticks but what can you do?

The other must haves were: (Shown in Top Picture)

• Sharps container (free pick up/drop off in my county at the local health department/fire stations)
• A by-HOUR daily calendar (b/c the log books they give you just don't leave a lot of room for writing; found on clearance at Target for $5)
• Food scale with tare and g/oz/lb/kg options (EatSmart Precision Pro Digital; $25, Amazon.com)
• The aforementioned insulin koozies which will save you easy money b/c dropping 1 vial of insulin is EXPENSIVE (Securitee Blanket Vial Protectors, $7/each at Amazon.com)
• The aforementioned CalorieKing Calorie, Fat & Carbohydrate Counter is a MUST, MUST for proper D care. I received one free from the Endo but purchased others for babysitter/grandma, grandma #2, main car, etc. ($5, Amazon.com)

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Eventually our daily needs stash was pared down, so I went on to the next find: IKEA 

Ikealand was kind enough to make these kitchen accessories that are sort of perfect for D supplies. The little steel organizer bar allows you to pick the perfect containers to hang, which I selected two flatware caddies and a flat bottom wire basket. Caddy #1 gets alcohol pads; Caddy #2 (usually) holds a fast acting gel, pens/sharpies, Crystal Light liquid and anti-itch cream if we need it after a site change. The wire basket is a catch-all with lancets, blood meter supplies, calculator, insulin, ketone strips, pump clips, etc. It freed up the counter to throw the food scale and logbook underneath it. Nice, neat, organized, and ACCESSIBLE. 

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Other Important Items: 

• 3 tier plastic bin for the extra items like swabs, lancets, blood glucose strips, instruction manuals, extra meters/lancing devices, needles, etc. (I did the snap-by-layer kind but the drawer kind could also work for you; I liked mine b/c the top layer had multiple compartments to organize the smaller stuff, and I didn't have to worry about items getting stuck/jammed in the drawers.). Once we started accumulating things, this went into a kitchen cabinet along with the gobs of pump and CGM supplies. 
• Small Cooler (Ours is the Icy Diamond Small Insulated Tote; $21 at Amazon.com)
• Binder for all the D-paperwork. I used clear plastic sleeves to easily flip through them. It's got everything from the Doctor's info to the free foods (under 5g) that she is allowed, to insurance letters and RX info. I decorated mine with some snazzy scrapbooking paper and glitter letters I had already on hand.

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Vacation worries were solved when I stumbled across the Joy Mangano XL Beauty case. This thing is like the Cadillac of organizers. I did a test run with things still in boxes and ended up with room to spare. The large section had 6+ Dexcom (dexcom.com) sensors alone (hard to see) and I could've added plenty on top. When we took a cross-country trip to L.A., I was able to use this perfectly at the airport because the sections velcro on/off. Non-scannable items in one packet to hand to security, one packet had food/drink for plane ride, and the other 2 were for scannable medical supplies. It folds into around 12"x6"x6" with a handle and since it would be all medical supplies within it, does not count towards your carry-on luggage tally. 

Joy Mangano XL Beauty case

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Preschool?

Found this adorable toddler backpack by Skip Hop, which the teacher would keep. A Vera Bradley ID case on a carbinder is perfect for Dexcom receivers. The middle section has a pencil holder with her Glucagon, jellybeans, fast acting gel, glucose tablets, juice, etc. The front pocket holds her meter kit, pump remote, ketone meter/strips, and her data phone. Side pocket holds a water bottle (even the tall reusable Contigo's). 

So there you have it, a bit of insight into how we started out organizing, and what we do now that we are years into it. Disclaimer: Aside from being a Dexcom Warrior, none of the aforementioned products are affiliated with me/this blog in any way.