Out of Line or On Point?

I was reading the article High Blood Glucose What's Behind the Symptoms? on Diabetes Self Management and I, once again, began blogging in my head.  (I'm going to try to get it out here this time though, because my brain is kind of crowded these days.) 

It took me back to shortly after Ally's diagnosis.  Our lives had been turned upside down and we were on information overload.  We were learning the difference in high blood glucose and low blood glucose.  Heck, we even had to learn what blood glucose meant - for real!

We were at a follow up appointment at the endocrinologist's office.  The nurse educator stopped in to continue our diabetes education.  After all, the 8 hour crash course we received in the hospital at diagnosis couldn't possibly cover all things diabetes.  She asked me if I knew about neuropathy.  I did not appreciate her concern on that day.  I was five months pregnant, brand new to diabetes, tired, overwhelmed, sad...I responded, "Yes, I have read about it, but honestly I have blocked it out.  That's the way I'm coping for now, blocking out all the bad things."  She did not like my response.  In fact, she responded in a downright rude way.

Maybe I deserved it.  Maybe she just wanted to make sure that I understood that there are serious complications of diabetes.  Maybe she didn't like my attitude.  Who knows!  But what I do know is that she was not wrong for trying to educate us about the long term complications of diabetes.  I think that, in the moment, I thought that I did not need to worry about these complications.  I think that I was sure those things would never happen to us, or at least I didn't need to think about them for many years.  I was wrong.

You see, high blood glucose causes permanent damage to your body.  It doesn't happen when you are a certain age.  It happens slowly over time.  But each and every high blood glucose contributes to these complications.  The nurse educator was not out of line for "putting me in my place".  She was giving us the knowledge and tools to keep those complications at bay for as long as possible.  She was making sure that we understood the importance of keeping blood sugars in control.  She was on point, and for that, I am grateful.

Hello? Is this thing on?

I have been blogging in my head for months now.  Trust me when I tell you it is some great stuff!  Only problem is that you couldn't hear it could you?  (I think the microphone was on mute.)

 

Well, you are lucky enough to hear what's on my mind today!  Insurance!  I am so grateful for our health insurance, really, I am!!  But sometimes it causes me undo stress.  Why does it have to be so confusing?  I don't get that.

 

Our insurance has not changed.  Not even the copay amount, which seems to have gone up each of the past several years.  Nothing changed.  They sent us a new card, actually 5 new cards!  Yep, I have to carry a separate card for each individual member of our family.  And each of these cards now has a new ID number.  Nothing about our insurance changed.  However, because the ID number changed, EVERY SINGLE doctor, pharmacy, medical supply company, etc, etc, has to re-enter all of the insurance information.  I keep getting calls saying that our insurance is not valid.  It is, they just need the new number.

 

This week, I get a call from the medical supply company that ships Ally's insulin pump supplies along with her CGM sensors.  They need the new info before they can ship her supplies this month.  No problem.  I had to call back as I had missed their call.  After waiting 40 minutes on hold, I spoke with a customer service individual, who had to transfer me to another department because there are sensors on her order...and those are "specialty" items!  After waiting another 40 minutes, I was irritated knowing that they only needed my daughter's new ID number.  Pink cheeks. 

 

The kind woman tells me that we are all set.  "How would you like to cover your copay?  It will be $6 hundred...blah...blah...blah."  Sorry, I didn't hear anything after the words six hundred!  She said that our insurance pays 20%.  Wait!  Our insurance pays 90%!  Pinker cheeks.

 

I told her not to process the order because that cannot be correct.  I immediately called our insurance company and waited another 20 minutes on hold.  She confirmed that nothing had changed on our insurance and her supplies were definitely covered at 90%.  After another call to supply company and another 40 minutes of waiting, I finally got it all resolved.  Same exact copay that I had been paying for the past year plus her deductible.  So basically, I spent over 2 hours unnecessarily.  Red cheeks!

 

I realize this is not the insurance company's fault.  Well, maybe if they hadn't changed those silly ID numbers!  It is just so frustrating!!!

 

This little incident has me thinking about Ally's future.  Funny how so many things have me going there in my head...she's only 9 for goodness sakes!  As I sat there, in my flush-faced frustration, I thought to myself Ally will have to deal with this for her whole life.  And then I began thinking about how I will prepare her for this part of managing her diabetes, so that one day when she does have to handle these insurance incidents, she will handle it with more grace than I did! 

 

So, when I figure out how to understand insurance and get organized with it, I will most definitely begin a plan for preparing Ally for this stuff!  The only notes I've made in my notebook to future Ally are 1) Know your insurance!  Know your deductables, and plan ahead for those - they will surprise you every January if you don't.  Know your copays.  Know what is covered, and at what %;  2) Pay attention!  Pay attention to the EOBs.  Pay attention to the bills that come.  and 3) Be organized.

That's all I've got!

 

In the meantime, feel free to share your ideas for the future Ally about staying on top of insurance :) 

A Very Unlikely Shout Out

Ally had to have knee surgery yesterday.  The poor girl has gone through so much in her short life.  Sometimes I feel like its just so unfair.  It makes me feel better to blame diabetes for the crappy stuff that happens.  Only this time, the orthopedic surgeon tells us that this is not related to her diabetes or her JIA (Juvenile Idiopathic Arthritis).  He said this is a normal person problem!  Gee, how did she get so lucky to have a normal person problem too??

 This is a picture of the MRI.  You can see a piece of cartilage & small piece of bone that have broken off bottom of femur bone. (It looks like a half moon shape, located in middle of picture.)

After meeting with the surgeon, I felt comfortable and even though I wished that Ally did not have to go through this procedure, I felt good that he could fix it.

My anxiety was with the whole idea of putting her under for the 2 hour surgery.  Maybe anxiety isn't the right word...panic may be better.  I almost couldn't breathe thinking about her being away from us for 3-4 hours, under anesthesia.  How could I be sure that someone was monitoring her diabetes during that time?  You might say, well she WAS in a hospital, surrounded by doctors and nurses right?  But  being a doctor or a nurse does not mean that you understand how to manage diabetes.   

The surgeon and his team assured me that they would work closely with our diabetes team and that they would be monitoring her blood sugars the entire time that she was away from us.

I spoke with our endo and nurses in the diabetes clinic several times before the big surgery day.  They instructed us to keep her BG in range as much as possible overnight and leading into surgery.  They wanted to keep her basal rate the same, but add extra BG checks to  make sure she was holding steady.  We had a pretty good plan in place, but most of you know how hard it is to "plan" a blood sugar number.  Yeah, nearly impossible! 

Ally could not eat after 3 am and could have clear liquids only until 7 am.  Since her basal rate increases at 6 am, I was mostly worried about her going low and having to treat it.  If she were to need juice or something to treat a low blood sugar, they would have to cancel surgery.  So I set a temp basal decrease for a couple of hours beginning at 6 am. 

Once she got her IV they would be able to pump glucose through that if she were low...I just had to get her to that point.   I had a goal of a BG between 150-200 when we left for the hospital.  This is higher than her normal range, but I felt better giving myself a little cushion because I could give her insulin but I wouldn't be able to give her sugar if she were low.  I knew they would be checking her...and they did every hour, or more if they thought she was dropping. I also guessed that the stress of the surgery would make her bg climb. 

Leaving our house, BG 165.  Going into surgery, BG 156.  Three hours later, coming out of surgery, BG 155.  The flat line of her CGM overnight was beautiful!

It may sound as though I am tooting our own horn here...but I'm really giving a shout out to the big D for cooperating! 

I can't even believe that I'm saying this out loud (and Lora, you warned me, so I'm giving you permission to say I told you so, when this comes back to bite me!).  D actually cooperated!  I know, that may be something you have never heard before.  I can't even believe it myself.

We were even blessed with a perfect CGM sensor that has been dead on!

Surgery went well.  Ok, except for the going to sleep part.  She freaked out a little...or a lot!  She was nervous and kept saying that she wasn't ready.  Then they let her put the mask on, she tried, but chickened out and pulled it off.  Then she started screaming that she felt low (I'm sure she inhaled just enough gas to make her feel that way).  Then when they had to force the mask on, she screamed HELP!  HELP! until she fell asleep.  It was traumatic.  I prayed that she wouldn't remember it and at first it seemed that she hadn't.  When she woke up she said, "I think I worried for nothing."  and "I'm really glad that they let me hold the mask myself.  I don't even remember falling asleep."  I felt a huge relief that she had not remembered that awful moment and wished there was a way for me to forget it.  Then today she said that when she tells people about the going to sleep part, she will leave out the part where she screamed HELP!  :(  I guess she remembered after all :(

Ally is doing well today.  She is having a moderate amount of pain, but that was to be expected.  She will not be able to bear any weight on her leg for 6 weeks.  As much fun as she thought the crutches were going to be, I think we are going to be spending a lot of time on this couch!

I am going to take advantage of this opportunity to get some extra snuggles for sure!  So happy that this week is over and so very proud of my brave girl!  She wrote me this note from the couch today between naps...

"Thanks (for telling me I'm brave)! You Rock!"


No sweet girl, YOU ROCK!!