Stage 1: Denial. [The double entendres write themselves!] A few weeks after your endocrinologist appointment/pump supply shipment/eye exam, that bill arrives. You know the bill — THAT one. You know it’s a bill because you rip the corner off of the outer envelope and see the return envelope inside. Once you realize it’s a bill, you leave it on the kitchen counter to mature with the bananas and the cherry tomatoes. You pretend it’s not there, and that things might get sorted out all on their own.
Stage 2: Anger. The Explanation of Benefits arrives from the insurance company. You open it, and decide to go ahead and open the bill, too — just to compare dollar amounts and obscure service codes and descriptions. That’s when you realize that The Thing That’s Supposed to Be Covered, as well as The Thing You Need to Manage Your Diabetes Like A Responsible Person, will not be covered, and that you owe close to $1,200. Expletives fill the house like leftover test strips, and you toss the envelopes and papers into your purse, intending to make some very official phone calls at work the next day.
Stage 3: Bargaining. “I got this,” you think to yourself. “Certainly there’s a normal person at the insurance company who will understand that I need things like test strips and appointments with my Certified Diabetes Educator in order to survive. And certainly that person will see that the insurance company is wrong in rejecting my claim. We’ll get this resolved in no time!” Halfway through your phone call, however, you begin to wonder if anyone at the insurance company cares if you live or die. “If I can conference the provider in on this call, can we work this out?” you ask. “Could you pay, like, 20% of this total? Is there anything I can do to make this happen?” Sadly, no. No on all counts.
Step 4: Depression. Later that night, you reach into your stash of all-important and still-not-paid-for diabetes supplies, only to discover that you are almost out. This is when you collapse into a blabbering blob of ugly-cry, snorting and sobbing, face-down on your bed. Seeking comfort and reassurance, you go back and reread Lee Ann’s amazing post on the helplessness of negotiating with insurance companies, only to find yourself even more disheartened. “Why do we ALL have to deal with this?” you cry out into the cold, cruel universe. As you bust into your second box of Kleenex, you tell yourself that it’s all too much anyway, and that you might as well just give up — go back to the 2-shots-a-day Regular/NPH routine you subsisted on in the early 1990s. Who needs life-saving and -extending advances in treatment when trying to pay for them makes you want to throw yourself into the nearest body of water?
Step 5: Acceptance. After days on hold with medical providers and insurance companies, writing multiple letters to multiple parties who don’t want to hear from you unless you’re calling with a credit card number, you accept that, with time, you might be able to get this thing straightened out. And if not, there are options. You can always change providers, take a break from the sensors, or get a second job to pay for all the stuff that’s not covered. You can always drive a bus through the insurance company headquarters. Even if you do get all of this straightened out, you accept the fact that it will happen again next year, and the year after that, and every year that follows until your diabetes is cured or insurance companies begin to make decisions that are truly in the best interest of their members’ health.
You accept that this is the reality of health care for people with chronic conditions — at least, those of us who are lucky enough to have insurance at all. You buck up, and you pick up the phone to make another call.