The high cost of "insurance gaps" if you have diabetes

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A good life with type 1 diabetes requires much more than a healthy diet and regular exercise.

Type 1 diabetes is an inconspicuous autoimmune type of diabetes that causes a person to stop producing insulin, the hormone that all mammals need to stay alive.

A person with the disease has to have quarterly medical appointments that come with a variety of blood tests to assess if their medication needs to be adjusted and if their total blood levels are in the safest range.

You also need a large amount of life-saving insulin and medical technology.

It would be almost impossible to pay for this technology and treatment out of pocket.

A study published in the July issue of University of Michigan's Health Affairs found that 1 in 4 adults with type 1 diabetes had no health insurance for at least 30 days.

More importantly, the average length of stay of those persons without insurance cover was three years.

The cost of diabetes

The cost of insulin and test strips, which cost nearly US $ 1,000 per month, can be devastating for people with diabetes and their overall well-being for 30 days without insurance.

The study reports that people with type 1 diabetes who are covered by insurance for more than 30 days are five times more likely to come to the ER or emergency center.

If they live in poverty or a low-income household, they can easily decide if they want to pay their rent instead of buying more test strips or insulin for a month.

This decision leaves them no choice but to become either homeless or put their lives in great danger by taking less insulin than they need to keep their ampoule of insulin longer.

The modern technology of diabetes treatment includes an insulin pump and a continuous glucose monitor (CGM). It allows people with type 1 diabetes to lead safer lives while keeping blood sugar levels well below normal levels.

These items are almost impossible without insurance.

A new insulin pump and a new CGM cost about $ 5,000 per bag. It's more than $ 500 a month for on-going deliveries.

Just a few months can be devastating

A gap in the cover directly disturbs the patient's blood sugar stability and worsens hemoglobin A1c levels. This measurement shows the blood glucose level over a period of two to three months and therefore increases their risk of developing complications over time, such as retinopathy or neuropathy.

Andrew Hair found himself at the age of 23 when he was released from his job, only a few months without insurance.

Before losing his health insurance, he used the most basic methods to treat his type 1 diabetes. These included syringes, insulin and a basic glucometer for blood glucose monitoring.

However, those few months without insurance were some of the most stressful he ever had to endure.

"This gap in health insurance has put a lot of strain on my life," said Hair Healthline. "Luckily I was already a subscriber to One Drop for my test strips."

One Drop is a groundbreaking "disorder" in the diabetes technology and pharmaceutical world. It was founded by Jeff Dachis, who has diabetes himself.

A mission of the company is to help people like Hair by providing unlimited test strips for a monthly subscription fee.

The strips are shipped directly to the consumer without prescription from a physician or approval from an insurance company.

Without insurance, traditional test strips from a pharmacy would cost more than $ 1 a strip. The average patient uses four to eight test strips per day.

Most insurance companies limit their patients to four strips a day, unless a clear need for more is stated in writing by a physician.

Patients would then pay their monthly payments, generally between $ 30 and $ 40, for that predetermined, limited number of strips per month.

A monthly subscription of $ 39.99 with One Drop means that Hair can order more strips at any time to use with their One Drop Meter.

But insulin, which is affordable, is not yet possible.

While there are many patient care programs offered by pharmaceutical companies, they are often based on your total annual income, not your current shortage of income and insurance cover.

Immediate support is not what it was designed for. And qualifying for one of these programs is not a fast process.

"My out-of-pocket insulin costs during those few months without insurance were close to $ 600 a month," said Hair. "And I am happy that I do not need as much insulin as the average diabetic."

While Hair continued to search for a new job, his fear of not being able to afford insulin only got worse. It added stress, depression and anxiety to his daily life.

"I am grateful to be employed again today, but to be without insurance for a few months gave me a perspective that I did not have before," he said. "I can not imagine how hard it will be to manage diabetes without insurance for an even longer period of time."

Complications happen

The treatment of diabetes may also require other unexpected treatments and procedures.

Even with well-managed diabetes, any type 1 diabetes can develop complications such as cataracts.

"I had to pay more than $ 8,000 for cataract surgery in 2008," said Ceara Ryan, who had a type 1 diabetes diagnosis 40 years ago when she was 8 years old.

While cataract surgery is generally not an emergency situation, delaying the surgery may cause your eyesight to temporarily deteriorate, and your ophthalmologist may have other symptoms, such as: As diabetic retinopathy prevented.

Ryan told Healthline that she had a supply of supplies for her insulin pump during her insurance gap.

This helped her avoid having to switch back to injections or pay more than $ 1,000 a month to continue using her pump.

But she physically paid a price by trying to use the last drop of insulin in her pump.

"I would leave my pump sides as long as possible," Ryan said.

The infusion sites of the insulin pump sit in the uppermost layer of the skin, where the insulin is then released. They should not be worn for more than three days, although normally 30 or more units of insulin are still in the reservoir when it is to be replaced.

"I had huge amounts of scars all over my torso," Ryan said.

Still uninsured, Ryan said she's fighting for the medical expenses that keep her alive.

Right place, right time

Others, thanks to the right connections, can endure a period without insurance.

After being released from her job, Samantha Galvez knew she would have access to insulin and test strips from a less traditional warehouse after her insurance expired: Diabetes Camp.

Galvez, now 26, received a type 1 diabetes diagnosis at the age of 13.

She was a counselor in a diabetes camp during the gap in her health care.

"Fortunately, the diabetes camp was just around the corner, so I knew I'd get a lot of extra insulin after the camp ended," Galvez told Healthline.

This simple resource probably saved her thousands of dollars, preventing her from ever "saving" her insulin and raising her blood sugar to keep an ampule out as long as possible.

"For me, the hardest part was not having health insurance, getting my non-diabetic prescriptions and making appointments with diabetes specialists," Galvez explained.

She pursued Medicaid and was qualified for a period of time, but found the approval process complicated and encountered many obstacles each time she tried to get the medical care she needed.

"I ended up paying hundreds of dollars for at least two prescriptions out of my pocket because Medicaid made things so confusing," she said. "Fortunately, I knew that I was unemployed for only two months, knowing that I would soon get a job with health insurance was the only reason I did not completely lose my inner peace, keeping my stress at bay "

More than expected

Researchers in this latest study said they were not surprised that people with type 1 diabetes are so severely affected by a lack of health insurance.

However, they said that the frequency with which people experienced these gaps was unexpected.

"Type 1 diabetes requires intensive day-to-day management to keep it simple, so interrupting care and coverage of insulin and accessories can be a major risk," said Mary AM Rogers, PhD, University of Michigan Medical researcher School, which led the study, in a press release. "While we expected gaps in coverage to affect health in some way, the size of the effect and the frequency of gaps were conspicuous."

Rogers attributes the frequency of these gaps to the growing trend of short-term employment and the growing number of private employers who do not offer health insurance.

"Our study shows fragmented care for adults with type 1 diabetes in the US," said Rogers. "Such gaps in healthcare have been found in people who use Medicaid, but we report that it also occurs in adults who have private health insurance, and we know that ensuring continuity of care for patients with diabetes important and with less mortality. "

Rogers predicts that this problem will get worse over time as insurance coverage in the United States becomes a more important issue caught in an endless political debate.

"This problem will not disappear," said Rogers. "If anything, fragmented care is likely to increase with projected trends, but access to health care is vital for people with type 1 diabetes, and access to healthcare for people with chronic illness is a problem that America has not fully resolved Has. "

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