The last couple of weeks of the insurance plan year are always a bit tense as I walk this tightrope between insurance coverage, flexible spending account funds, and diabetes supplies.
Our health insurance plan year begins on July 1 annually. For some families, it’s January 1.
By June each year, we have used up the pre-tax money that we allotted to our flexible spending account (FSA). I try to hold off on major medical expenses like ordering three-month supplies of insulin, insulin pump supplies, or continuous glucose monitor (CGM) sensors because each of these come with a hefty price tag even after insurance coverage.
But, with the new plan year I know I will likely have a few hoops to jump through.
The insulin my daughter uses isn’t the preferred brand so I will have to take at least 90 minutes out of my day to try to get to the right person in the right office to get an override.
Our prescription plan deductible also starts over, so the first few prescriptions are always more expensive than normal.
Of course, any medication or supply might be delayed because insurance will want a new prescription.
So here were my choices:
- Order the supplies and medications that we were running short on and pay a huge chunk of change out of pocket.
- Wait until July 1 so that we could use our pre-tax FSA account, not have to write a huge check because it’s taken directly from the paycheck, but risk having delays and legwork.
I literally counted the number of pods we had in the supply cabinet, retrieved the ones that remained in the school diabetes supplies, and borrowed from our emergency kit, to see if we could squeak through until July 1.
And even if there were enough, I had to consider possible insurance delays and shipping time.
And then I thought I’d order a box of 10 pods and then order two more boxes come July 1. That makes sense, right? Oh, but then the insulin pump and insurance companies may question me ordering again so soon even though I didn’t get a full three-month order.
Nothing is ever easy when it comes to diabetes. This end-of-the-plan-year conundrum gets me every time.
I wish there was a “my daughter will always have type 1 diabetes so please just consider all her prescriptions and supplies medical necessities for, well, forever and continue to cover and approve them without question or the need for 17 phone calls” box or category.
I decided to wait until July 1 to order both insulin and pods. Did I get them right away? Of course not! The pharmacy was out of stock, and I wasn’t able to pick up the prescription until a week later. The pods shipped on July 3, but because Insulet now uses SmartPost (terribly slow!), the estimated arrival date wasn’t until July 10th.
We managed to get through without running out of anything, but it was too close for my comfort.
How do you deal with this delicate balance of having enough supplies and waiting for insurance coverage and FSA fund availability?
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