Insurance

Mark it: September 23, 2015, the first day that my new job’s health insurance (theoretically) (officially) kicks in.

I still kind of can’t believe it. I don’t have the card yet, so…

But if it’s true, if it has kicked in, if I soon get the card and get to be swallowed up in the comforting embrace of the capitalist industrial health insurance complex—yes, thank you, thank you, thank you.

Diabetes is, for so many reasons, a noose around my neck. Physically, emotionally, yes, but also, holy crap, financially.

Want to hear something absolutely crazy? About a year before I got diabetes, when I didn’t really know what it was, and when I certainly didn’t know the difference between Type 1 and Type 2 diabetes, I found an article online (somewhere?) by a girl defending the arrival of Obamacare. She tells her story: she was young, healthy, health-insurance-free, living the life, when she suddenly started experiencing strange symptoms: excessive thirst that wouldn’t go away, unexplained weight loss, peeing all the time (SOUND FAMILIAR?).

A few weeks later, yup, she was hospitalized with DKA; except in her case, her lack of insurance guaranteed her about $30,000 worth of medical bills plus, you know, a regular stream of insane expenses that ensured her slavery to credit card debt was essentially unending. Things got really dicey when she no longer had any credit on said credit cards on which to charge her insulin or diabetes supplies — and literally could not afford the medicine that was keeping her alive. (The whole time, she was searching for full time work that would provide benefits, and, happily, she ultimately found it. She wrote the article to be like “gee, wouldn’t it have been great if there had been a plan in place for people like me at the time, not able to go on medicaid because I was working freelance, but unable to afford the thousands of dollars of expense my disease was costing me without insurance”)

Anyway, I’ve tried to find this article again several times since I was diagnosed – at the time, it struck me as strange and upsetting in a distant, totally unrelatable way. Now, of course, it would hit much closer to home. I can’t find it anymore, though. Has anyone reading this blog read that article?? Or did I, as I’m beginning to fear, actually just invent it in my own head, so terrified am I of the financial responsibility of my illness?

I am fortunate that I was insured when I had my $21,000 hospital visit, and remained insured (although with a crappy plan, but holy crap any crappy plan is better than no plan) to this day. However, my grasp on my current insurance is, for many reasons, slipping, and to make a long and boring story short, and I really need my new job’s insurance to kick in when it’s promised it’s going to.

Because just for fun, I tried to calculate the day-by-day cost of what it would mean for me to live uninsured with diabetes.

And by “fun”, of course, I mean, like, “terror”.

Without insurance, my current insulin, the Humalog 100u/ml vial which I use in my pump, is available on this shady website for $265. That lasts me about three and a half weeks, or 24 days, which works out to $11/day. 

You can buy the test strips I use, sans insurance, on Amazon.com for $71.95 for a pack of 100, which works out to 72 cents apiece. I will generously say that I use 12 a day (even though some days it’s more like 20…), which is $8.64/day.

Without insurance, the infusion sets I use in my pump are available on this shady website for $103 for a pack of 10, (retail value $135! a steal!). That’s $10.30 each, and each lasts me about 2 days, so another $5.50/day.

My cartridges are for sale on this shady website for $48 for a box of 10, or $4.80 each. They each last me about 3 days, so that’s another $1.60 a day.

Byram Healthcare, on behalf of Dexcom, the maker of my continuous glucose monitor, bills my health insurance $974 for a 3-month supply of CGMS transmitters. So, if $974 covers me for 90 days, that works out to $10.82/day.

The Dexcom itself, as well as my pump, were, of course, one time expenses, so it’s a little harder to amortize that on a day-to-day basis. However, I’ll do so based on the warranty of both of those items. My pump has a warranty of 4 years, and it cost my insurance company $6,832.00. Divided by the 1460 days in 4 years, that’s $4.68/day. Meanwhile, the Dexcom receiver cost my insurance company $5002, with a 1 year warranty, which works out to $13.70/day, and the transmitter cost my insurance company $1450 with a 6-month warranty, which works out to $8.05/day.

Now, all diabetics on pumps really have to have back-up insulin, which hopefully you don’t have to use, but realistically you will have to use. Let’s lowball this, too, though, and assume I never have to use them, just that I have them. I keep an Apidra kwikpen on me at all times in case my pump malfunctions (and I have DEFINITELY needed it before.) Once you take it out of the fridge, it lasts 30 days. This shady website is selling them for $511 for a pack of 5, or $102.20 each. If one lasts me a month (assuming I never use it), that’s $3.40/day.

If I have back up fast-acting insulin, I’m also going to need back up Lantus, too. Good ol’ America’s trusted online pharmacy has ’em, too, for $443 for a 5 pack, or $88.60 each (again, one would be a 30 day supply because of its expiration date when unrefrigerated), so that would work out to another $2.95/day.

Any kwikpens I’m using for back up I’ll need pen needles for. Since it’s back up, I’ll assume a box of 50 will last me, oh, 6 months. On amazon, I can get a box of 50 for $29.94, which, if it’s lasting me 6 months, is only adding .16/day (what a steal!).

Alright, so let’s hold it there. I haven’t bothered including the cost of alcohol swipes, which we’re all supposed to use but none of us bother to (except the really good diabetics, and good for you guys), as well as the cost of a glucometer, which is one thing every diabetic can be SURE they’ll get for free. I also haven’t brought up the $$ I spend on juice, glucose tablets, and sodas for emergencies, the blankets and gloves I bought last winter because my circulation was so bad, the lotion when my skin gets completely dried and cracked, etc., because Part 1 of this exercise got me so depressed I can’t possibly keep going.

Because even if I hold it there, just those medical things add up to an astounding $70.50 a day.

Psh, you say, Jessie, I have $70.50! That’s not so bad!

Sure. Except $70.50 a day is $2,115 a month. Which I most assuredly don’t have. Or, if I can pull it together this month, I sure as hell can’t pull it together for the $25,380 it’s going to cost me a year to stay alive. 

I know, I know. If I didn’t have insurance, I would pare down a lot of this. Of course. I wouldn’t have a Dexcom, and I wouldn’t be on a pump. But listen, people, it’s not like I’m buying a private jet or a thousand silk scarves or something. My pump and my Dexcom are imperfect but inordinately useful medical devices that have kept me alive (and I can say that with assurance, given how many times the Dexcom has woken me up in the middle of the night because my blood sugar is tanking.)

And honestly, even the bare-bones, just-keep-me-alive-if-barely plan, where I just do shots and don’t have a pump and don’t use the dexcom, and magically only need to test 4 times a day (ha!), and have no back ups somehow, is still costing me, in my quick calculations, $25.36 a day, or $760.80 a month, or $9,129 a year. But honestly, if I don’t have a Dexcom or a pump, and I can only test 4 times a day, I’m probably going to wind up in the emergency room, so why doncha go ahead and tack another $30,000 onto the $9,129.

And oh yeah, I also haven’t even BEGUN to explore what it would cost to see a doctor without insurance. All of these calculations, of course, assume that I am a diabetic who magically doesn’t ever need to see a doctor or get blood drawn or have my A1C tested. You know.

So, yeah, insurance is terrible and all medicine should be free, but since it is literally the only thing between me and tens of thousands of dollars of debt, I am going to go ahead and thank every god I’ve ever prayed to for 9/23/15, if that card does indeed come, because HOLY CRAP YOU GUYS.