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August 22, 2002

Insurance/Costs

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Question from Milwaukee, Wisconsin, USA:

While my mom was in the hospital for chest pains, they took urine and came back stating she could possibly have sugar diabetes. The problem she has is that her insurance (through my dad’s job) does not cover her receiving a blood sugar monitor or to seeing a dietitian or diabetes educator, and she needs all this to get this under control and to stay alive.

I feel so badly for her because she does not know what to eat to get blood sugars down, and she does not need her blood sugars to be to low. I have been doing research on the Internet for recipes on diabetes. Maybe that will help. I know the seriousness of having diabetes and not taking care of yourself.

Can you provide information about organizations that provide free classes and monitors for people whose insurance will not them?

Answer:

From: DTeam Staff

You state that they said your mom possibly has diabetes, not that she has been diagnosed. It seems to me that her first step should be to determine whether or not she actually does have it. If she does, then please note the comments from others, below.

Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes Guidelines for further information.

Occasionally, lab blood sugar testing might be normal in an early case of diabetes, repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test, might be appropriate if there is a high suspicion of diabetes despite normal initial testing. Another test, the glycosylated hemoglobin, might be used to help confirm a suspected diagnosis of diabetes, but the GHB (also called HbA1c or A1c) is not usually considered as appropriate to make an initial diagnosis. Antibody testing is occasionally done as a screening test in high-risk situations, or as confirmatory of type type 1A (autoimmune) diabetes, but is not part of routine testing.

Urine sugar tests or home glucose testing, if done, might be positive, which would make the situation more urgent to get lab testing done to confirm the abnormal results. However, urine or home glucose testing, if negative, would not exclude diabetes.

SS
Additional comments from David Mendosa, A Writer on the Web:

According to the American Association of Diabetes Educators, Wisconsin is one of the states that requires health insurance providers to cover diabetes education, equipment, and supplies. In addition, the American Diabetes Association states that Wisconsin is one of the states that “provide coverage for diabetes supplies and self-management education as part of basic coverage (at no additional cost).”

DM
Additional comments from David S. Holtzman, Esq.:

I am sorry to learn that your family’s health insurance policy will not cover the cost of diabetes care. I would encourage your mother and father to seek special coverage by the plan. They should schedule a meeting with the plan administrator or benefits administrator to discuss their needs.

To prepare for this meeting, they should bring a letter from your mother’s physician describing your mother’s condition and his suggested treatment regimen that includes that blood glucose monitoring is being recommended.

An alternative is to contact the Diabetes Control Program with the Wisconsin Department of Health to learn of a low cost diabetes training program in your area.

DSH