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November 18, 2002

Insurance/Costs

Question from New York, New York, USA:

My son has been using a glucose meter for the last which five years with minimal adult supervision, only to have our insurance company change its designation to different meter requiring a parent to supervise to ensure he has sufficient blood. Hence we are having to pay upwards of $100 a month on strips because we are not using the the insurance company's designated meter. Can you help us contact the insurance company and argue on behalf of us so that we may continue to use the other meter without the undue financial burden it is currently causing? Our son's health would be compromised if we had to use their formally deignated product.

Answer:

Our role here is not to take a direct role in representing individuals in their disputes with healthcare payers. State laws permit managed care organizations to establish formularies that can limit subscriber choices to certain pharmaceuticals or brands of durable medical goods like blood glucose monitors and strips.

If you choose to use another brand of monitor, you will have to pay for it out of pocket or pay a higher deductible. Another option, if you or your spouse works for an employer that offers a choice of several health plans, you should investigate changing plans. A point of service or indemnity plan may provide you with better benefits, although they usually cost more.

DSH