There is no question that diabetes is an expensive disease. And negotiating the insurance scene can be complicated and confusing. In fact, do you really understand your health benefits? Obviously, the purpose of health insurance is to save out-of-pocket expenses for health care. But to ensure you receive all the benefits you're entitled to so you don't spend more than you should, you must understand the finer points of your insurance coverage.
- Does the plan allow referral to an endocrinologist, or must you be treated by your primary care physician?
- How many physician and education visits does the plan cover?
- Do you have coverage for diabetes education, including nutrition education? In some states, insurance companies provide coverage for diabetes education if the program has been recognized by the American Diabetes Association or the State Department of Health as meeting certain standards of care and education.
- Does your plan specify what type of meter or brand of insulin you can purchase?
- If your insurance does not cover expenses for preventive diabetes care, consider submitting a letter of medical necessity for services and supplies to encourage the insurance company to cover these costs. Sometimes a physician's letter or support of the cost-effectiveness of diabetes education from your educator can supply insurance companies with rationale for providing the coverage you need. A copy of this letter should also be given to your employee benefits personnel so your employer can also encourage the insurance company to supply coverage of diabetes care.
- To reduce costs, consider mail ordering three-month supplies of insulin or other equipment you need to manage your diabetes. It may be much less expensive.
Talk with your insurance agent or employee benefits representative if you have any questions. And follow this advice for coping with the paperwork:
- Make sure you file your claims to the proper portion of your benefit plan; most plans have basic and supplemental portions.
- Try not to file a claim until your expenses exceed your yearly deductible, but don't delay filing. Generally, claims must be filed by the end of the calendar year following the year the charges were incurred.
- Submit itemized bills. Balance due, paid on account, and cash register receipts may not be acceptable. Bills should include the name and address of the provider, patient's full name, date of service, description of services performed, amount charged for each service, and the diagnosis.
- Keep copies of your submissions for your files.
- If your coverage includes a prescription plan, learn how prescriptions should be written. For example, some plans cover a three-month supply of medication, and prescriptions must be written that way. Other plans request that all medications be written on one prescription. Know what your plan requires, and ask your doctor's office to place this information in your records so you will not endure a delay when you need supplies.
If you're considering switching to a new plan or policy, be sure to find out if any new plan contains a preexisting illness clause that either excludes coverage of diabetes care completely or excludes care for a certain waiting period (such as six months to a year). Be truthful when you fill out insurance applications. Misrepresentation can lead to cancellation of your policy and denial of benefits. If you apply for coverage and are denied, provide evidence that diabetes is well controlled and that you are either free of complications or they are stabilized. Your doctor can help by submitting a letter with laboratory results confirming good control. You should also inquire about state services for people with diabetes. Many states now have "pooled risk" insurance plans for people who have difficulty getting group coverage. The premiums for these plans may be a bit higher than others, but you can purchase comprehensive health insurance at an affordable cost. Contact the Office of the Insurance Commissioner in your state. Consider reducing your premium costs by choosing higher deductibles.Another outlet that can help you manage your diabetes care is the many support groups that are available for diabetes patients. We'll learn about these groups in the next section.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.