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[IP] Michigan Health Plans Question Diabetes-Coverage ...
Just when we thought we had it worked out....
LANSING, Mich., Mar 27, 2001, (A. M. Best via COMTEX) -- Health insurers are
questioning the necessity of a diabetes-coverage law that goes into effect
March 28 in Michigan.
"Medical care moves at a rapid pace. What you mandate tomorrow may not be the
standard next week," said Gene Farnum, executive director of the Michigan
Association of Health Plans. "What we object to is putting medical care and
treatment into legislation. If you mandate everything, no one can afford the
The 25 health plans represented by the Association insure about 2.9 million
people and are prepared for compliance, Farnum said.
"Our plans basically do everything that the legislation requires," Farnum
said. For example, the legislation calls for diabetes education--something
the Association has been doing for about three years, he said.
Many of the groups belonging to Blue Cross Blue Shield of Michigan had been
moving voluntarily toward offering these types of benefits--many offering the
coverage as an option, said Helen Stojic, a Michigan Blues spokeswoman. The
Michigan Blues cover about 4.8 million people.
Like the Michigan Association, Stojic said the Michigan Blues object only to
health-care mandates. "We prefer the voluntary approach and believe there
should be choice in the marketplace and employers should be able to choose
the options best suited to their work force. They should have the flexibility
to choose the type of coverage they want to provide," she said.
Mandates also interfere with employer-union collective-bargaining agreements,
Farnum said. "They have bargained and agreed on what the health coverage
should be. When you mandate, you override that agreement," he said.
Michigan's legislation provides coverage for diabetes-related programs,
equipment and pharmaceuticals, said Julie Smith, spokeswoman for the Michigan
Office of Financial and Insurance Services. The legislation includes coverage
for gestational, insulin-dependent and noninsulin-dependent diabetes.
The coverage provided for in the legislation is not subject to dollar limits,
deductibles or copayment provisions that are generally greater than those for
physical illness. It also varies according to types of insurance.
Insurers, nonprofit health-care corporations and health maintenance
organizations also must regularly measure the effectiveness of their
prevention programs by surveying individuals and report survey results after
two years to the Michigan Department of Community Health.
The legislation provides for coverage of blood glucose monitors and blood
glucose monitors for the legally blind; test strips for glucose monitors;
visual reading and urine-testing strips; lancets and spring-powered lancet
devices; syringes; and insulin pumps and medical supplies required for the
use of an insulin pump.
Coverage provided through employer self-funded plans or Medicare are not
affected by the legislation, Smith said.
(By Dennis Kelly, associate editor, BestWeek: dennis.kellyambest.com)
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