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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? 

                   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
                   non-insulin-using diabetes. 

                   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,

                   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
                   and cooperation. 

                               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. 
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