Q&A: Is it legal to exclude Diabetes Education from a Health Policy?
Is it legal to exclude Diabetes Education from a Health Policy?
The insurance my company has been providing has told me that, at my company’s request, Diabetes Education is an excluded benefit. We are now getting a new insurance company, and again I am being told it is not covered, at the request of my company. There seem to be laws, though, that state if diabetes is a covered condition, self-management education has to be included as well. Has anyone else heard of this, or run into it? What can I do?
Best answer:
Answer by john e russo md facm faafp
If you have diabetes diabetic education should be an included health benefit. Unfortunately an insurance company does have the right to exclude such eduction. It is not illegal but it certainly would not be appropriate.
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Insurance companies are such a gimmick. My old insurance company would not even cover my Lantus or Humalog pens. They made me use needles and syringes because the pens were not a “necessity”. Now I am on a new insurance. My husband has a state job and we got the best policy they offered. They even told me they covered insulin pumps and now that I am trying to get one they don’t want to cover the one I want. I pay hundreds of dollars to them and they don’t even want to cover the supplies I need? Yes, leave it to american health insurance companies… Here is a website that offers information about state laws regarding diabetes. If you google it you will probably also find other information. http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/legal-protections/state-laws-and-policies.html
In the meantime you may be able to apply for financial assistance at your local hospital. If you have health insurance already, you may not be approved, but most hospitals go by a sliding scale and it depends on your income. You could get full coverage or just partial. Also check into your local clinics, they sometimes to educational things. Good luck!
Legally an insurance company can delete or restrict just about any service as long as they can prove it would not cause injury or death to their members- Deleting diabetes education is certainly allowed, especially since insurance company would expect/require the doctors office could do this at no added cost. Options: If homebound, maybe insurance would cover a visiting nurse to monitor and educate the patient or contact local hospital and diabetes groups who often provide education at a free or reduced cost.