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From Fayetteville, Arkansas, USA:

My question is not for me or anyone I know, but just relating to something on your site that bothered me. As I was reading your "Behavior" section, I noticed that in a majority of cases the Diabetes Team member recommended psychiatric or psychological counseling for teens/parents dealing with diabetes-related emotional problems. That sounds good on paper, but given the difficulty diabetics have even getting rudimentary medical insurance, what are the chances that people with diabetes can swing psychological counseling bills? We know that diabetes takes a financial as well as emotional toll on many families.

I ask this because I feel that your advice is usually well-thought out and good-intentioned--but the practical side of who picks up the bills for expensive counseling can't be ignored. The best advice in the world won't help you a bit if you can't afford to take it.


I hate what fees are charged and what is not covered when the issue is so important! I myself have seen patients for ten dollars an hour, because they needed it! Maybe that is why I am not rich, but I am good at this work and my heart aches for that person who "falls through the cracks" in the healthcare system.


Additional comments from Dr. Lebinger:

As we have discussed many times, there are many problems with insurance reimbursement for many aspects of care. Unfortunately, the fact remains that many psychological issues need the help of an experienced counsellor to be resolved and if unresolved can seriously interfere with the child's or family's ability to cope with the stress of diabetes. I think we all need to pressure or legislators to improve reimbursement for all aspects of diabetes care, including psychological. In the meantime, there are often clinics that offer care on a sliding scale based on ability to pay for individuals with poor coverage.


[Editor's comment: It has been difficult at times to write replies, and edit replies, when I know that many of the readers at this website may not have access to the full spectrum of diabetes services (either because of finances or distance, or both) that might be available to other people. By and large, we've taken the viewpoint that we should supply state-of-the-art information, even though we fully recognize that the care we advise may not be available everywhere to everybody.

We do try to make allowances in our replies for extreme situations, especially when the questioner clearly specifies a problem: for example, for writers from other parts of the world who indicate they do not have local access to specialists in diabetes, or for people who indicate a financial issue as part of their problem. WWQ]

Original posting 23 Jul 1998
Posted to Social Issues: Insurance/Costs


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Last Updated: Tuesday April 06, 2010 15:08:58
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