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Re: [IP] Health insurance in DC/MD/VA area

Subject: Re: [IP] Health insurance in DC/MD/VA area
2 As a diabetic on an HMO, I should remind you that generalities are
dangerous.  My primary care physician is very lenient with me seeing my
endo.  There are also endo's within the plan that serve as primary's.  This
is definitely


Most assuredly!

I'm a more-or-less happy member of Aetna Managed Choice here in California.

1) Referrals to specialists (except for your initial referral) are not
required for continuing care for the same chronic problem.  This was a rule
change in the last two years.  Cost to me for each visit: $10 copayment
2) Pump was 100% covered.  However, it did take quite a few months to work
through the approval process.
3) Pump supplies are 100% covered - I get a nice UPS box once a month.
4) Education was covered minus a $10 copayment.

Of course, all of these are specific to my employer's agreement with Aetna.

It does help, while you are out interviewing your primary care physician to
tell her/him that you expect to be referred to a specialist for diabetes
care.  Also helps when you ask your specialist to recommend a PCP.
Basically, if I get the flu or break a thumb I see my PCP.  If it is related
to managing diabetes I see the specialist.

On the other hand, don't even ask me about the time Aetna dropped my PCPs
medical group.  Why?  The group apparently exceeded referral and/or test

Good and bad, but it is working for me at the moment.


Insulin-Pumpers website http://www.insulin-pumpers.org/