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Re: [IP] Insurance coverage

In a message dated 2/21/00 9:44:26 PM US Eastern Standard Time, 
email @ redacted writes:

<< What state are you in, which insurance co.?? Most of the states with 
 "required" coverage for diabetes also require glucagon coverage. >>

Hi Michael

I'm in Indiana, which does require coverage for DM supplies (in fact, I 
testified in favor of the bill at the request of the ADA). However, companies 
that are self-funded are regulated by ERISA, which I'll try to give a 
nutshell explanation of. Any lawyers on this list who deal with corporate law 
will, I'm sure, correct any errors on my part. :-)

ERISA stands for Employee Retirement Income Security Act of 1974, but ERISA 
also regulates self-funded insurance plans. Those companies do not have to 
provide coverage as stipulated by state law. ERISA preempts state law. Most 
large companies are self-funded and, therefore, fall under ERISA.  Like the 
company my coverage is through. 

However, as I noted in my letter, the company is very responsive and did put 
an override on there for me so the glucagon (now residing in my refrigerator) 
was covered. Knowing them, they also put an override on for all the other 
DM-ers who are covered under their policy.

What I was trying to point out in my letter was a good thing -- that I had a 
problem, which was a problem only because staff benefits did not know what 
glucagon was for. Staff benefits only knew that it was an injectible, was not 
insulin or whatever the migraine injectible is, and therefore was not 
covered. Once the reason for the necessity of having glucagon available was 
pointed out, there was no problem. The change was made immediately.

In fact, they company didn't cover DM self-management education, either ... 
until I called, made an appointment, took over some information and advised 
them of the necessity of good DM education. It is now covered.

I think that, as knowledgeable people, we all have an obligation to educate 
staff benefits -- and the people who make the decisions on coverage -- on the 
benefits of good DM care. Be calm, back up your claims with statistics, and 
leave lots of printed material for them to ponder. :-) I'm told the materials 
I took to the vp in charge of determining coverage is now in a diabetes 

As was the case today, I didn't accuse or get angry. I merely said the kit 
was not covered and asked why. When told why, I told them why it should be. 
They agreed with me. I like it when people agree with me. LOL

Jan and Elvis
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