Here at TFD, we believe healthcare should be affordable and accessible for everyone, without needing to find loopholes — which is not currently the case. This is one person’s story about how she has been able to lower the ongoing costs of her diabetes. As you read on, do keep in mind that this is just one individual’s experience, and these tips may not be applicable to everyone.
I was diagnosed with type one diabetes in the 9th grade. My parents struggled with pricey insurance plans, but were always able to fill my prescriptions and get me to the doctor for regular visits. I knew, on some level, that the insulin, test strips, lancets, doctor’s visits, syringes, lab work, and glucose monitors were expensive, but the full extent of the cost of keeping me alive didn’t click for me until I had to pay for it myself.
My first job out of college paid $36,000 a year, and I quickly realized that after rent, medical costs were by far my highest monthly expense. Between doctor’s visits, pharmacy runs, and lab tests, I was not only eating up any possible fun spending (vacation funds) or responsible spending (student loan repayment), but I could barely afford the handful of new outfits I needed to transition my wardrobe from college kid to grown professional. And for me, that was not okay.
Thus began my quest to save money on medicine over the course of almost two decades since my diagnosis. They haven’t cured diabetes yet, but with these tips, I can report I now have a robust travel fund and make regular payments on my student loans.
1. Getting a good job (with good health insurance)
For as long as I can remember, my parents told me to get good grades so that I could go to college and get a good job. And I did, or so I thought. As a teenager and in my early twenties, I believed any job with a benefits package that included health insurance was a “good job.” And all of that is true, but there’s more.
As I negotiated new jobs, until recently, I always focused on the salary. But I’ve learned there’s more to a compensation package than a salary. I now ask directly about the health insurance package in order to understand how much my copays will be, as well as my deductible and out-of-pocket maximum. Ultimately, if I’m considering two different positions, while one company may offer a higher salary by $2-3k, that may not be the best overall offer if the healthcare plan isn’t competitive. In fact, I have negotiated a higher starting salary to compensate for a crap deductible. I knew it was the right role for me, but I explained that their healthcare costs were too high, so the overall compensation package would have meant a cut to income for my family. The company got the memo and increased the salary to cover my deductible.
2. Getting a good doctor
It took me over a decade to figure out that a good doctor is not only important in terms of maintaining my health — but that a good doctor will take into consideration the financial burden of the care she is prescribing. I’ve had some doctors approach cost from a “not-my-job” standpoint, and others who assumed they knew my financial situation without asking about it, making decisions on my behalf with incomplete information. I’ve learned that a good doctor will lay out multiple options for treatment and discuss their pros and cons — including relative cost! Moreover, I feel that great doctors will bend the rules when the rules benefit the insurance companies rather than their patients. (See items 3-5.)
3. Asking about cost and coverage
Doctor’s offices are full of hustle-and-bustle as patients churn in and out, and — for me, at least — it’s easy to get swept up trying to accommodate their pace. However, what I’ve learned after hundreds of visits to the doctor is that I am the patient and the customer. Therefore, I can ask all of my questions, including how much a procedure or treatment will cost and whether or not my insurance will cover it. Doctors sometimes pretend that cost isn’t a factor, but very few of us are wealthy enough for the cost to be completely irrelevant. I shamelessly practice in the mirror before I leave, write all my questions down in case I need to read them in person, and repeat them again in my car on the way to the appointment. Sometimes they don’t know exact numbers, but with a little persistence, I can usually find out generally what I should expect to pay out of pocket. Regardless, I still practice saying “I need some time to think through my options” before every appointment.
4. Asking for a bigger dose
One key way I’ve saved money over the years (beyond using generic prescriptions) is to ask for a bigger dose than I really need for the month. For diabetes, I have to fill 6-8 prescriptions a month, just for basic care. Even at the low end of prescription costs, it starts to add up fast! So, I’ve had doctors write me a one-month prescription for three months’ worth of insulin. It saves me money and time but requires getting a good doctor (remember step 2?). Even when I have had crappy doctors, I explained that arriving at the pharmacy right on the 29th day of each month is very difficult for a person as busy as me (I may or may not have flipped my hair). I explained that I traveled for work and often had to get to work before the pharmacy opened and work well past when the pharmacy closed. I didn’t always get three months for the price of one, but I usually managed to get a few extra weeks’ worth.
5. Asking for samples
Oh, samples! Don’t think free samples are just a Costco thing. Doctors get an insane amount of free samples from pharmaceutical companies. And while I know they have cupboards full of all of the stuff that I otherwise have to purchase at the pharmacy, for me, often the biggest barrier is asking. Maybe it is because I was raised to think of myself as a fully independent, capable and strong woman, or maybe it is because growing up, my family was still climbing the ladder to middle class, but proud of our progress, so quick to dismiss anything that might be considered “charity.” But I still struggle to ask for the freebies I know exist.
I have definitely asked for insulin samples when my month’s supply ran out early, and that was no problem, but there are other moments where I’ve forgotten my own golden rule. For instance, I’d had the same blood sugar meter for over a decade and needed to upgrade. I fought tooth and nail with my insurance. Many letters were sent. Many phone calls were made. I was unwilling to accept that they wouldn’t pay for a medical device that I needed on a very basic level to stay alive. Eventually, I won. But, a few months later, when my therapist said I should get an extra meter for by my bedside, I scoffed at her. Getting one was hard enough, let alone two. She said, “Ask Dr. Shah. He’ll get you one.” And sure enough, I went in and asked, and he asked me what kind of meter I currently had. I balked because I thought it was a test to see if I needed one or not, and I knew I had a brand new one in my purse. And he explained — “No, I just wanted to get you the same kind so that you don’t have to fill an additional prescription for two kinds of test strips.” And my head exploded, because that meant not only did he have meters, one of which he planned to gift to me, but that he definitely had a closet full of ALL the different kinds of meters. And now, I am the proud mom of two matching Verio One Touch meter twins — and, moreover, happy I asked.
6. Asking for help
I have always been lucky enough to be able to afford my prescriptions, but as a part of the diabetic community, I know that isn’t the case for everyone. I also know that there are a ton of resources out there to help — even in unexpected places. Doctors may be connected to programs that provide financial assistance — there are always signs in my endocrinologist’s office that say, “Struggling to pay for insulin? Let us know. We may be able to help.” I have also seen employers step in to help. A stellar employee needed a drug that wasn’t covered through our plan, and the company I worked for actually switched insurance providers in order to keep that employee. But the company never would have changed if she hadn’t called her boss to let him know about her particular challenge. And, of course, seeking out a community will always be key for me. Diabetics have all sorts of pay-it-forward groups where supplies are shared at low or no cost among fellow diabetics. Having a community of folks who know the diabetic struggle and are eager to help with tips, tricks, advice, and sometimes, supplies, sustains me (both fiscally and spiritually).
7. Searching out prescription cards
These babies are magical! So, I chose my last doctor because she was also a leading researcher in the field of type 1 diabetes, which meant she always had the newest and hippest treatments — and strong opinions about them. With her help, I changed both the insulins I use — long-acting and short-acting — for better products that more closely mimic the body’s natural insulin activity. The catch is, of course, that both of these new insulins are still crazy expensive. So, along with the prescription, she also gave me a rebate card, which, when used with any other insurance, guarantees an out of pocket cost of just $15. This saves me — without exaggeration — thousands of dollars every thirty days. And, the best part is, even though I recently moved out of state and had to leave my fabulous doctor behind, these cards are available online. I lost my first one for Afrezza, an inhaled insulin, and with a few simple clicks, I was able to print out a brand new one.
8. Shopping around (with and without prescriptions)
Although I don’t buy insulin online, being diabetic requires a lot of accessories that I’m more than comfortable buying from a reputable online retailer — things like test strips and pen needles. With my insurance through my pharmacy, I pay $45 per month for a box of pen needles. I can find the same name brand item for $22.88 on Amazon, or as low as $8.99 for generic. Until I plugged in to the diabetes online community, I never considered “shopping around” for supplies, as I assumed if I had a prescription then I needed a prescription. And moreover, it meant the cost was fixed through my insurance. But, armed with my new knowledge, I’ll save almost $500 on pen needles this year, and close to $10,000 over the course of the next 20 years. That’s at least four international vacations, not that anyone is counting.
9. Double checking the receipts
It can sometimes feel like you need a Rosetta stone to read an Explanation of Benefits (EOB), but I have saved thousands of dollars by spotting what are usually minor clerical errors in my EOBs. One time a receptionist billed the wrong insurance (despite the fact that I had updated it both online and in person), resulting in a bill for over $3,000. Another time I had a scan done at the Emergency Room and the location was deemed “out of network” even though a) it was the emergency room, and b) the emergency room was in network (yes, I had checked). This one took some pushing, but eventually, the insurance covered the full cost. Yet another time I paid the out-of-pocket price (read: a lot) for a prescription and hadn’t noticed because I was paying for many prescriptions at once. No one at the pharmacy bothered to flag that my insurance had covered all of my prescriptions except one. I reviewed my receipt once I got home, caught the error, called the pharmacy, and together we figured out that the wrong insurance had been billed — but again, just for that one prescription.
Although it is inexplicable and annoying, mistakes happen constantly, so I have learned to always know what I expect to pay for each procedure or prescription and double check against what actually ends up being billed. I rejoice when I’m underbilled, and immediately get on the phone to get my money back when they charge too much!
Danielle DeSantis is a reluctant millennial living in Denver, Colorado. She likes puns, fat animals, yelling about politics, adventures and moral quandaries. For more of that, you can follow her on twitter here or on Instagram here.
Image via Unsplash