This trip is possible as a diabetic through a lot of hard work, prayer, and getting connected to the right people. When we first got serious about this trip we knew the biggest obstacle would be to get all of the prescriptions and supplies I needed. I have to admit that I first went to the trusty internet and researched to see if anyone had gone before me to see what they did. No real luck. I did find some forums that were country specific where people had posted their questions on how to obtain insulin, but mostly I found the responses were from people who thought they had the right answer but had not done it themselves – a BIG difference. It is because I had difficultly finding information on the web that I write this today.
So, first of all, let me be very clear that I am not a doctor and anything I write here is simply my opinion. However, I have been type 1 diabetic for 15 years and I have traveled internationally before. I also (unfortunately) have been in another country and needed to seek medical treatment, most recently in Thailand in 2006 for blown-out ear drum (not diabetes related).
So almost seven months ago I called my health insurance company and told them about the trip and asked how I could get enough prescriptions. They told me that their policy is to only allow 3 months of a vacation prescription supply at one time. Furthermore, I could only get two 3 months supplies in a calendar year and I would only be allowed to get the second 3 month supply if I ordered a sole one month supply in between. Hmm. . . because they seemed so adamant I didn’t push and instead set about figuring out how I would make this work.
Our trip is broken into two segments because of how we ‘bought’ (we’re actually using frequent flier miles) our plane tickets. This was also by design because we thought we would need to come back to pick up more prescriptions (and we still do because my diabetic supplies literally take up a whole suitcase, more information later). So the first part of the trip is 3.5 months and the second is 5 months. When I was working with the original 3 month vacation supply policy I did several things to start filling in the gaps:
1)I got connected with the diabetes educator at my endocrinologist’s office who was excited for me and knew the importance of me having all the supplies I needed (in particular insulin and blood glucose test strips). She began to gather free samples for me from the diabetes supply vendors.
2)My endocrinologist wrote a prescription for several more test strips than I actually use a month. (Although my insurance company caps the amount they will give in one month to 300 – and I use almost that every month). This allowed me to stock pile about a month’s extra.
3)Several family members who have been diagnosed as type 2 in the last several years gave or were going to give me some of their test strips.
4)I learned that I could reorder my prescriptions every 23 days and thus also stock pile a little.
5)On a calendar I worked out this 23 day schedule so that I would make sure to reorder as soon as I could but also because I was going to have to have my mom order a one month supply of prescriptions in December so that I could get another 3 month supply when I returned to the States in January before we took off again.
6)I began to heavily research how to get insulin and test strips in Thailand (where we would be when the second 3 month supply ran out). This included me emailing a hospital who told me I would have to see an endocrinologist there and have him/her write me a prescription to be filled in Thailand.
All said, a lot of work, BUT here’s the good news.
After all this was arranged or in the works, my health insurance plan was changed to a different plan, and because I wanted to ensure that the new plan would still allow me to get a 3 month vacation prescription supply I called to make sure. When I called I didn’t say anything about what I already knew – I simply told of my situation and posed the same question, ‘How do I get all my prescriptions?’ Either the woman I was talking to was new or she had a heart for wanting to help me because she said “Hmm. . . I don’t know, let me check into it and get back to you.” She called back later that day to say she was working on it with her supervisor and would get back to me the next day. The next day came and she called and said she needed another day. Well then 3 weeks passed. In the course of the next month and a half I called her twice and left messages.
Finally as time marched on I got more annoyed and worried that my fall-back patchwork plan (outlined above) wouldn’t work (or at the very least was and would be difficult to execute), so after leaving her a message that said call me back TODAY, and not hearing anything I called and talked to a new person. My new contact listened to the whole story and said she would get in contact with the woman who wasn’t calling me back and would call me back the next day. When this new woman forgot I called again the next day and talked to someone new. He told me that the first woman who was not calling me back had been very ill and had not been at work for a long time, a very good and sad explanation. He then read me the policy (two 3 month vacation supplies in a calendar year) and told me that I could buy my prescriptions out of pocket before I left and then when I got back call my health insurance provider who would (with the approval of a supervisor) send me a form that would (maybe – if approved) reimburse me for the cost minus my prescription co-pay. I calmly explained to him that the cost of my prescriptions out of pocket would be thousands of dollars and that I did not think this was a good option, especially considering the reimbursement required a supervisor’s approval. He then told me that he was instant messaging with the woman I had talked to the day before and that she would be willing to call me back today. I said I would like to talk to her. I promptly got off the phone and cried. Sometimes being an advocate for yourself day in and out gets exhausting and overwhelming.
I had it together by the time the woman called me back and to my great surprise she said that she and her supervisor thought that they could submit a form on my behalf requesting approval for 9 months worth of prescriptions. I was totally shocked. As she gathered information from me about the length of the trip two things stood out to me as particularly helpful to my cause (and maybe to yours). 1) The woman repeatedly made sure that this was not a business trip (I have no idea why) and 2) I told her to write down on the request that my health insurance contract was through July 2009 – which is what 9 months worth of prescriptions brought me to. This last point was important because I emphasized that there was no way that I was going to take their prescriptions and then get insurance through another company they were assured to get my contracted money. She typed this up and then submitted it to marketing (don’t you love that marketing is making decisions about my health, yes, it warms my heart too :) ). A day later (because they had expedited my request) I heard that my 9 month prescription request had been approved! HOORAY!!! I still get a little adrenaline rush from thinking about it.
However, the process was not quite over. My insurance company would only allow me to get my prescriptions one week before my departure date, which was tight for me because we were leaving our house to allow our renters to move in and were heading up to Seattle to stay with my parents. To make sure that everything would go as smoothly as possible I went into my pharmacy and talked to a cashier to explain my situation. She assured me that everything would be fine. I did not particularly like her answer because it came too quickly without much thought so I came back a few days later and talked to another cashier that knows me by name. She called a pharmacist to the counter to talk with me who not only was really excited for me but told me to call him personally on the earliest day I could order the prescriptions so that he could run them. Several days later I realized that all of my prescriptions would expire (they are only written for 1 year and most were half way through that year) before I would be able to get 9 months so I went in and talked to my pharmacist friend who sent faxes to all of my doctors explaining the situation and asking for a new prescription and also the approval to give 9 months worth. I followed up and called all of the doctors’ offices to make sure they got the forms and would complete them quickly.
On the earliest day I could order the prescriptions I called my pharmacist friend to put the order through. It wouldn’t go through!!! After talking to my health insurance company, my pharmacist friend called me to tell me that my carrier told him they would only allow 3 months of prescriptions at a time and that is why it wouldn’t go through. Fortunately for me I had the direct phone number of the pharmacy services supervisor at my health insurance who had been working on my 9 month approval. I called and talked to her and explained the situation. After several minutes on hold she came back and said she had resolved the issue and that everything should go through. I called my pharmacy friend back and I was still on the phone with him when the prescription order went through. HOORAY!!!
However, the process was still not quite over! When I went to pick up my prescriptions the next day I found out that the company that the pharmacy orders supplies from had thought their request for the huge amount of blood glucose test strips I needed had been someone’s mistake, so they didn’t send them. Thankfully my pharmacist friend called them as soon as he learned of the problem and told them, ‘You are messing with someone’s life here, get those here today!’ I was able to pick them up several hours later.
SO, knowing all of this here’s my advice for a diabetic who wants to travel internationally for longer periods of time:
1)Call your insurance company and be persistent – tell them there has to be a way for them to approve your prescriptions in advance. Talk to or get a supervisor involved.
2)Work with one pharmacist who knows your story.
3)Have direct numbers for all parties who know what’s going on and perhaps backup people and their direct numbers because as you read in my experience many things went wrong and these people and their numbers became lifelines.
4)Tell someone at your endocrinologist’s/doctor’s office who can also be an advocate for you with your insurance company or in getting you some free samples.
5)Write thank you notes to anyone who helped you in this process, hoping that this will help pave the way for others coming behind you or maybe help change a policy.
I hope that there will be many other type 1 diabetics who travel the world. Good luck and good health!
Andrea
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1 comment:
Andrea you are amazing! This is really helpful information. I will probably refer back to it in planning for future travels. Good luck, my friend, and keep up the fight!
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