Of nickels and NIPs

First, my thanks to the commenters who offered feedback below on the Naomi Berrie Diabetes Center. I really appreciate the input. I'm looking at other options, though in the meantime I may end up there for a maintenance appointment. Foggy, Peculiar Violet also entertains a vague hope that her doctor there will be Miraculously Different.

Meanwhile, my company has changed insurance providers. A very strong plus is that I now have a network here in NY, whereas previously all my medical stuff was out of network and had to be paid up front, then reimbursed. (Ow.) Some of the other changes are more complex:

1. The highly-recommended-by-multiple-trustworthy-persons Dr. Carol Levy is not in the network. Rats. I could pay her up front, but I'll only get 60% back from the New Insurance Punks (NIPs). Multiply by 4x a year, and you see why I may end up at Naomi Berrie (whose providers are NIPpers).

2. I have a deductible now of $300. (Previously, I paid a higher premium to avoid a deductible, but that option is no longer available.) It doesn't apply to office visits or prescriptions, but it does apply to test strips and pump supplies. That means my first batch of strips, normally $90, will cost around $330, every year. After that, though, I will have 80% coverage, same as I previously did.

3. My current test strips aren't on the formulary. So I need to change to a different brand. That's okay; my meter is a piece of crap anyway. But now I need a new prescription. Maybe Dr. Reassurance will give me one. Hopefully this will be okay even though Dr. Reassurance is not (you guessed it) in the NIP network.

4. Luck of the diabetic: my current insulin, Novolog, IS on the formulary. Woo hoo! If I were still on Humalog, I'd have to change. It's not the end of the world, for me, to change between those insulins, but I do need more H than N, so I'd have to rework all my ratios, using many of the precious $330 test strips.

5. Lab work is 100% covered if conducted within the doctor's office. If not, it is 80% covered. Huh? What difference does it make where it happens, as long as the doc has ordered it? To NIP, the difference is apparently critical. (I think this is a ploy to get patients to come to the all-in-one NIP clinics, which adorn the city and suburbs of Minneapolis much as Starbucks coffee shops adorn Manhattan.) Of course, there are no NIP clinics in New York, and as noted below, it seems to be rather unusual to have blood work done in a doc's office here. Maybe they will do it at Naomi Berrie. Otherwise, I'll be paying 20% for my A1C, thyroid, cholesterol, etc. etc.

6. That said, if I keep my diabetic butt properly NIPped by remaining in the network, my annual out-of-pocket max is $1500 (plus my premiums, of course). Hey, that's not bad! And easier to attain with the jumpstart offered by the $330 test strips! Throw in some pump supplies and a few prescriptions (plus some lab work), and I should hit the max around September or so--not this year, when I'm starting at $0 on June 1, but in the future. Then it will be freebies through New Year's, huzzah.

My quiet ranting aside, this is good coverage based on what I know so far. I don't think I have much to complain about, assuming (major assumption) that I can get acceptable care from the NIPpers. One of the first experiments will occur next month, when I will visit a gynecologist whom I chose based on her office location, gender, and the fact that we have the same first name. (I had to draw the line somehow...)

All this makes me terribly curious about the diabetes costs incurred by the OC. How does your insurance treat you? And if you don't have insurance, how (the hell) do you manage?