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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. >>
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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