September 10, 2001
Insurance/Costs
Question from Weymouth, Massachusetts, USA:
I am in the process of investigating the pricing policy of diabetes supplies as it relates to my insurance company and was wondering where to turn. My prescriptions are covered by a separate company not related to my medical coverage. When my son’s prescription for strips is written six to seven times a day, I get charged a double premium since it is above the norm that was set by the insurance company. Is this kind of pricing considered discriminatory? When my coverage was handled by my medical plan, it never mattered how many times he checked in a month. As it is, all diabetes supplies are priced in the higher category, and the strips for the best meters are not listed so we have to pay an even higher premium for the meter of our choice. My son is six and was diagnosed at age three. We have a long way till Medicare!
Answer:
You have to check and see if your plan pays for all the strips you need in a certain period of time (for instance in a month, three months, six months) or if it will only pay for a certain fixed number of strips at a time (usually 100) regardless of how often your child tests. Usually insurance plans pay for supplies over a set time period. If this is the case, you have to fight your insurance plan to reimburse you for the appropriate number of strips you need according to what his doctor writes.
You might have to ask your doctor to write a short note stating that this number of strips is “medically necessary” because your son has severely fluctuating blood sugars. Plan to threaten to write to your state’s attorney general if they don’t comply. If your plan only pays for a certain fixed number of strips at a time, I don’t think there is much you can do.
TGL
