[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]
Re: [IP] Re: insulin-pumpers-digest V3 #823
> My question relates to insurance coverage.
> He has Connecticare (formerly Kaiser Permanente, Farmington,
> Connecticut). They barely begin to cover anything (really, only
> $100 to $200 of the pump and NOTHING else). Although I would be
> willing to save up and get him on the pump, I have been seeing
> several subscribers writing about differences between statutory
> requirements (what an insurance company has to cover) and what the
> insurance company says they will. I have tried to get access to
> Connecticut General Statutues (re: insurance coverage) but have been
> pretty unsuccessful. Is there anyone who is from Connecticut and
> knows about state law requirements?
WHAT DOES THE LAW MEAN AND WHAT DOES IT
It means that if your insurance company is covered
by the new law, it must reimburse for diabetes
equipment and supplies that your doctor has deemed
medically necessary for the treatment of
insulin-dependent diabetes, including insulin-using
diabetes, gestational diabetes and
Diabetes equipment and supplies:
Coverage includes medically necessary equipment,
supplies and drugs prescribed by a licensed
Self-Management Training (Education):
Diabetes education is a cornerstone of quality
diabetes care. It is the process of providing the
person with diabetes the knowledge and skills
needed to perform self-care, prevent crises and
make life style changes required to effectively
prevent complications. The goal of the process is
to enable the person with diabetes to assume
his/her appropriate role as an active participant
in the treatment plan.
However, the Connecticut law does not guarantee
reimbursement for self-management education. The
American Diabetes Association encourages you to
call 1-888-DIABETES to become a Diabetes Advocate
in order to effect this change.
Be sure to gather and keep all documentation to
substantiate your medical need for equipment and
supplies. Your insurance company may require a
deductible, copayment or coinsurance.
WHO IS COVERED BY THE NEW LAW?
*You can be reimbursed for diabetes equipment and
supplies if you have an individual or group health
insurance plan governed by the State of
WHO IS NOT COVERED BY THE NEW LAW?
*You are not covered if your plan is a "selffunded"
plan governed by a federal law called "ERISA."
*You are not covered if you are a Medicare* (see
below) or Medicaid recipient. Passage of this
legislation does NOT change the coverage in these
Your benefits manager or human resourcedepartment
should be able to tell you about your plan.
WHEN DOES THE COVERAGE BEGIN?
The new law applies to all insurance plans issued
for delivery or renewed on or after October 1,
WHO CAN I THANK FOR THIS IMPORTANT NEW LAW?
Governor John G. Rowland signed the bill enacting
diabetes insurance coverage.
The American Diabetes Association would also like
to thank the American Association of Diabetes
Educators, the American Dietetic Association and
the Juvenile Diabetes Foundation for their support
Where Can I Get More Information?
To learn more about diabetes, or to find out
more about diabetes advocacy, contact the
American Diabetes Association at
Where Can I Get More Information If I Am
Trouble With My Insurance Carrier?
To receive insurance coverage information,
contact the Connecticut Department of
Insurance, P.O. Box 816, Hartford,
Connecticut, 06142-0816 or the Consumer
Helpline at 1-800-203-3447.
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml