Our HMO is trying to force us to use specific brands of diabetes care supplies, i.e., test meter, test strips, insulin pump, etc. Can they legally force us to use only the ones they want (which are inferior) or do we have some right that allows use the ones we think are best?

Unfortunately, your HMO does have the right to dictate which brands of diabetes products they will cover. There may be a clause in your policy whereby you can purchase different brands at an increased out-of-pocket expense to you. Alternatively, it is sometimes possible to have your physician write a letter to the medical director of the HMO stating reasons why you need to use brands other than those offered. Then, sometimes, you can get full coverage.

I am not sure whether or not there are “inferior” brands of products. While it is true that individuals have preferences as to which brands they like to use, and, each manufactures offers features which appeal to some and not others, all of the products have had to meet certain standards in order to gain FDA approval for use in the United States.

Health insurance providers, such as HMOs, negotiate contracts with certain manufacturers to provide necessary products at the lowest cost to the insurer. While this practice is distasteful to some, it does allow the insurers to provide services to the masses in their plan which might not otherwise be possible. It is important for consumers to look carefully at that benefits and flexibility that health insurance plans afford. Each individual plan is different, even within the same insurance company. Once again, unfortunately, at present, many people do not have the option to choose among a variety of health insurance plans and weigh their options. I am at a loss to provide insight into this problem.

Therefore, for now, I guess you can: (1) try the suggestions described earlier; (2) explore other insurance options for you; or (3) pay out-of-pocket for the supplies you want.

SS