January 11, 2002
Question from San Diego, California, USA:
My wife has type 1 diabetes, and we belong to a health insurance plan which has grouped blood glucose monitoring with "durable equipment coverage" and raised the copayment from a flat $10 per prescription to 20% of the cost of the strips. Two years ago, I thought a law was passed limiting the charge for glucose strips. My wife checks her blood sugars eight to nine times a day to and uses an insulin pump to reduce the long term effects of uncontrolled diabetes, and now she is being charged more for that. Is there anyone I should start a letter writing campaign to? What should I do?
Get your diabetes team to write letters to your insurance company, and you should also write to your insurance company. Whoever at your place of employment who is responsible for purchasing health care insurance, should also write letters and consider changing to an alternative source.
You should contact the local American Diabetes Association office and find out what the local state laws are about insurance companies and glucose testing equipment. They may have some other resources as well.
Additional comments from David S. Holtzman, Esq.:
Save your postage. Section 1367.51 of the California Health & Safety Code requires HMO’s (like Kaiser) to provide coverage for diabetes self-management education, equipment and supplies. While plans are required to cover SMBG [Self Monitoring of Blood Glucose] strips and monitors they are permitted to assess copayments or coinsurance for these items so long as they are consistent with coverage for similar services or things under the policy. While many plans at one time classified strips as covered under the pharmacy portion of the plan or insurance policy, most now cover them as durable medical equipment items. And the plan is permitted to charge the copayment it levies for other DME [Durable Medical Equipment] items.
One reason for the realignment of these items under DME is that the Centers for Medicare & Medicaid Services (formerly HCFA), the folks who administer the Medicare & Medicaid programs, classify SMBG strips and monitors as DME items. Since Medicare pays for DME items but not pharmaceutical products, many plans now classify these items as DME.
If you still have questions complaints regarding your health plan, contact the California Department of Managed Health Care. You can find their contact information on the state’s website or in the telephone book.