It is problematic deal with health insurance companies. The goal of insurance in this day and age, is to put obstacles in front of your health.
Is there anyone listening on the other end of this phone? “What do you mean I only get 3 test strips a day? You must not be listening because I need to check pre- and post-prandial blood glucose levels three times daily. How will I know if my insulin regimen was enough to cover my meal if you take the strips away?”
Did you know you can get insurance to pay for more test strips per day if you have your doctor send them a letter stating that is medically necessary?
But, no one told me that, when I called my insurance company to ask if I could get more.
That may be true, but you have a right to proper health care.
I know what you’re going through with the insurance companies. Not only am I a psychotherapist who works with people living with diabetes like you, but I also have diabetes too, and I go through these same conversations with the health insurance companies myself. I know both sides of this discussion as a patient like you and also as a healthcare professional.
Advocate for yourself and ask to speak to a supervisor if you feel it is warranted or call back. Sometimes the first person you reach has a lack of knowledge about diabetes or how we need to care for it.
Fact: If your general practitioner on your health plan prescribes any medication or medical device or refers you to a specialist then it is deemed medically necessary.
When it comes to finding a diabetic specialist, it is a whole new ball game. For many, this is a very confusing situation. Some examples include (1) you may have insurance but can’t go out of network or (2) your specialist is not on your insurance plan. There also may be no Certified Diabetic Educators (CDE) in your area on your plan, but if you could go out of network, there is a nutritionist who is a CDE one block from your home.
Wondering how to navigate these situations? Here’s how:
Don’t worry. Most insurance companies have what is called “Single-Case Agreements.”
A single case agreement is a contract between an individual patient’s insurance company and a treatment provider that allows that patient to be treated as though he or she has in-network benefits.
Insurance providers who offer single-case contracts will review potential agreements on a patient-by-patient basis.
It’s important to note that the agreement is specific to the current episode of care and does not apply to care outside of this treatment episode.
Remember: you pay them. You should be getting what you pay for from your health insurance provider.
To get help or for more information on Diabetes-Focused Psychotherapy go to Eliot’s website or set up a free 30-minute phone consultation.
Eliot LeBow, LCSW, CDE, is a diabetes-focused psychotherapist. His private practice, located in New York City and is also available via Skype. LeBow, who has been living with type 1 diabetes since 1977, treats the many diverse cognitive, behavioral, and emotional needs of people living with type 1 and type 2 diabetes.
Medical Disclaimer:
All the advice included in this blog is therapeutic in nature and should not be considered medical advice. Before making any changes to your diabetes maintenance program, please consult with your primary physician or endocrinologist.
