Playing the Insurance Game
March 01, 2003
The first thing you should do when you are diagnosed with diabetes is to sit down and read your health insurance policies. You need to know what is covered and what isn't.
Then call them and ask them on the phone what you need. It's easier than doing it wrong and dealing with getting it redone. I know, I've been there.
Here how it works for me:
I'm on an HMO, and I pay a higher premium for a lower co-pay and to get to choose my providers.
My school district has chosen to use a different pharmacy service, rather than using the HMO pharmacy services.
Here's what you need to know:
What is durable equipment?
For example, my CPAP machine is durable equipment, but the masks, hoses, and filters are not. However, if my doctor orders them, they cover them. If they break and I decide to replace them, I have to pay for them. In other words, if something breaks, I call the doctor and see if he will order it. 9 times out of 10 he will.
Blood sugar monitors are considered durable equipment by my HMO. However most manufacturers give you the monitor. Look at it for their point of view. The monitor is a one time cost -- usually under $100. Test strips run around $50.00 per 100. The happier they make you, the more likely you are to buy test strips.
Do they cover needles?
Mine does. However, the doctor has to write a script for them. The pharmacy wants the doctor to write down how many in one day I will use, and let them calculate the totoal.
Do they cover insulin?
Mine does. They do prefer that I do 90-day mail order, and so do I. It's $40 a month if I get it from the local pharmacy and $40 for 3 months if I do mail order. However, you need to watch the weather. I'm in Texas, and I will want to be home to take delivery in the summer. So far, it hasn't been a problem and the cold paks still have ice crystals.
Again, they want the doctor to write down the daily dose and let them calculate the total.
Do they cover alcohol swaps?
I honestly don't know, they are cheap, and I found I can't do injections if I have to use alcohol. It's a personal thing.
Do they cover test strips?
Mine does. However, they really want me to use the Accu-Check. So far, I haven't heard anything good about Accu-Check and I love my Freestyle. My service again, wants the doctor to write down how many times to test.
FYI: My pharmacy service refuses to let me get more than 100 test strips per month through the local service. Anymore than that, and I am required to go through mail order.
They probably do that on the insulin too, but I haven't asked.