Diabetes Technology Blog

Wednesday, July 01, 2009

Dealing with one of my fears

From time to time I'm reminded about just how devastating diabetes might be. In this case I'm not thinking of the various complications that we think about all the time. This is a situation that those of us in the US are more in danger of encountering

Until yesterday, I thought that personal bankruptcy was really reserved for those of us without insurance. But the article Insured, but Bankrupted by Health Crises in yesterday's New York Times points out that being insured doesn't mean I'll be saved from financial woes. Hearing that "an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured" does not make it easy to sleep at night.

For me living with diabetes is all about balance, nothing new about this if you've been living with diabetes at all. But here's a situation that I just can't balance out.

Since being laid off earlier in the year my insurance is provided thanks to COBRA. But that will expire in the middle of next year and my insurance choices at that stage may be severely limited. With an 'existing condition' my chances of getting coverage for diabetes costs are zero unless I have a full-time job with health insurance by then.

But here's something that I may be able to affect positively. I'm going to write to my federal representatives and let them know just how important health insurance legislation is for me and my family. Not being covered is a challenge for me that strains our budget. But declaring bankruptcy affects my family and I don't like it when something threatens people I love.

Can I ask for your help?

I know from years of contacting elected officials that a note in the mail is often the most effective way to get their attention. A hand-written note really wakes them up, but even a typed letter goes a long way. Look up your elected federal officials and drop them a quick note telling them why access to real insurance is so important to you. If they hear from a handful of us it might just make the difference when it counts most.

Labels: bankruptcy, congress, coverage, debt, insurance

Thursday, September 25, 2008

Working to get coverage

I've been using a Dexcom continuous glucose monitor for nearly 18 months now. In all that time I haven't been able to get my insurance company (Aetna) to cover the costs. I just heard from Dexcom that Aetna has made them a provider, though there are still many hoops to jump through before I get reimbursement. I'll post with more details once I have those.

Most (all?) of us with diabetes have been denied coverage for thing needed to maintain control of our diabetes. In fact, insurance coverage for chronic illnesses is fairly bad in the US (and often worse in other countries). Today the Wall Street Journal published a short article on getting coverage, Pushing Back When Insurers Deny Coverage for Treatment.

They've provided a list of things you can do to improve your chances of getting insurance to cover treatment.

Find out what led to the denial
Learn how to appeal the denial
Take detailed notes, including dates and names, when you talk with the company
Get a copy of your plan's detailed benefits language (Evidence of Coverage)
Find out what they consider to be medically necessary

Sometimes I've talked with insurance companies to find that the doctor's office has used the wrong diagnostic code when submitting the claim. Often the insurance company will even tell you which code they should have used, or which codes they've used in the past.

Persistence pays off in some cases, like the parable of the persistent widow. Just remember to be polite to the person you speak with at the insurance company - they're generally following rules and are usually helpful. And many situations are open to interpretation.

Have you had things that were denied that you managed to appeal successfully? What approaches worked for you?

Labels: appeal, coverage, insurance, wsj