January 10, 2003
Insurance/Costs
Question from Blanket, Texas, USA:
My 33 year old husband, who has type 1 diabetes and has been on an insulin pump for about three years, has COBRA health insurance, and we have a constant battle with the insurance company. The quality of his life and his health has really soared since being placed on the pump, and we couldn’t be more pleased with his progress. Diabetes is a financially costly disease, and so is the insurance.
I have talked with the state boards of insurance in two states, filed complaints against the insurance provider, went through the steps in filing a Federal complaint, called the insurance company repeatedly, and even called my local Senator, but I feel like it’s a loosing battle. Are there any advocacy groups that specialize in assisting people like us with this problem other than the State Board of Insurance?
Answer:
I’m afraid that I do not have sufficient information with which to help you. Is the health plan in which your husband is enrolled an HMO, PPO,or indemnity plan? Did your husband work in the same state in which you live? Is the plan self-funded by the employer, an ERISA plan or is the employer’s work locations only in one state?
You mentioned that he has been on the insulin pump for about three years. Were you covered by the same health insurance plan at that time? You mention that your husband is a COBRA participant in the health plan. Did your troubles with the health plan begin only when he converted to COBRA?
Are you aware that the Texas Department of Insurance has a consumer services bureau to enforce its progressive regulations on the coverage of diabetes treatment and supplies? If you contacted them, what was their response?
DSH
