I have been working very hard at trying to keep myself in good control and trying not to give in to burnout. In doing so, I test my blood sugars routinely 7 to 10 times a day. All last year, my company's policy covered all my diabetes supplies, allowing me to get three 100 count boxes of test strips a month. Now this year, they've changed the policy, so they will only cover one box of strips a month, which as you can guess is not enough for me, and has greatly added to my stress because I cannot afford to be buying my supplies out of pocket every month. I've talked to the pharmacy and the insurance company, and they say its not them that set this change, its the company I work for. I then tried to talk to the benefits administrators of my company who were most unhelpful, saying that I would have to put my case in writing for a committee's review, which doesn't sound too promising to me. What are my possible options are at this point? Is there anything else I can do to get my company and insurance to cover more of my diabetes supplies? I am still going to be writing up a letter for this committee and I was wondering If there is a list of statistics, even if estimated, with the delineated costs to an individual with diabetes complications. Basically I want to try to show my company how it would be cheaper in the long run to simply cover more of my supplies now instead of dealing with the potential complications down the road, particularly since I have shown that I have been able to thus far stave off complications longer than the statistical average, through my intensive blood testings
As far as your request for coverage, you will probably have to address the committee at your employer. The business you work for has purchased a level of coverage that applies to you as one of their employees. If the type of coverage is not adequate, it is unlikely you will get very far with the insurance company. When you present your proposal in writing, you may want to impress them with the thought that you need to monitor frequently now to prevent problems later on. A good comparison would be the cost of the strips you use now compared with the cost of dialysis or lost days at work for retinopathy or neuropathy.
Those kind of examples would be enlightening to the uninformed. As to where you get the specific numbers, that is a little tougher. There are many models used to put a price on the cost for diabetes care. You may want to contact your insurance company or request some of the references they use.
Additional comments from David S. Holtzman, Esq.:Let's start with understanding your health insurance. There are three types of employer sponsored health insurance plans:
If your plan is subject to state regulation I would contact the Texas Department of Insurance for assistance. I will tell you that your utilization of strips is high compared to others. You will need a letter from your physician justifying your high utilization needs. If your plan is not subject to state regulation I would encourage you to meet with the benefits committee with your employer. Be prepared with backup from your physician. In addition, you may want to present them with copies of medical journal articles documenting the relationship between higher A1c levels and higher medical utilization costs. The CDC published a bibliography of articles associated with costs and economics of diabetes in 2000. You will probably find some references there.
- The first is that the employer has worksites located only in one state and purchases health insurance for which it pays a premium and employees and their dependents have the opportunity to subscribe to this plan, sometimes for a contribution towards the cost. In this circumstance, the policy is subject to the regulation of the state insurance department.
- The second is that the employer has worksites located only in two or more states and purchases health insurance for which it pays a premium and employees and their dependents have the opportunity to subscribe to this plan, sometimes for a contribution towards the cost. In this circumstance, the policy is subject only to the regulation of the state insurance department in which the plan is issued, and only for residents of that state.
- The third circumstance is that the employer's health insurance program is an ERISA benefit plan, or fully self-funded or self-insured and employees and their dependents have the opportunity to subscribe to this plan, sometimes for a contribution towards the cost. You can learn if you participate in an ERISA or self-funded plan by examining the benefit booklet given to participants in the plan. In this circumstance, the policy is NOT subject to the regulation of the state insurance department.
Another suggestion is that you offer to mail order all of your diabetes needs through a preferred provider; show some flexibility and willingness to think outside the box.
Original posting 10 Feb 2003
Posted to Insurance/Costs
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Last Updated: Tuesday April 06, 2010 15:09:42
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