Re: [IP] Insurance limiting # of test strips
>The way most group insurance plans work, the company that you work for
>sets up a health plan through a provider (Tricare, Aetna, United
>Healthcare, BlueCross / BlueShield, Kaiser, etc.) The provider has
>generic guidelines for plans, but the company that you work for sets
>the precise coverage. So you may find that two employers that use the
>same health coverage provider (in this case, Tricare) may actually
>have entirely difference coverage, with different limits, different
>formulary options, and different costs, etc.
I'm sorry if I was unclear. The individual employers DO determine the
precise coverage. Within a particular provider, there are levels of
coverage. There is usually a very basic plan, and the employer can
choose to take that basic plan, or pay a higher premium to get more
covered--BUT, they can't cover less than the most basic plan. I guess
I didn't emphasize the "less" part. So the higher the level of
coverage, the more stuff that gets covered. The employer can choose
to take only the basic coverage to offer to its employees, or it can
pay more to get additional things covered for its employees. So in
the case of test strips, the provider may have their most basic plan
that only covers 100 strips a month. One employer says that they want
the best coverage possible for their employees no matter what the
cost, and they pay a higher premium for that plan so that employees
can get their 300 strips a month without any hassle (the "without a
hassle" part is important and I am emphasizing this because medical
necessity is a wonderful thing to get more coverage than the hassle
free cutoff), a second employer says they recognize that the basic
plan might not be enough, but it's expensive to pay for the best plan
so they opt for a medium coverage level that will cover 200 strips a
month without hassle, and a third employer says they are really tight
for money and therefore they can only afford the basic plan which only
covers 100 strips a month without a hassle. This is where the
discrepency comes in.
Again, I'm sorry if my original post was unclear. I did not intend to
be. My point simply was, if someone writes a post saying "well I have
provider X too and they cover that for me with no questions asked,
therefore they have to cover it for you too", it is not necessarily
true and you need to go to your employer to get a description of what
your plan covers. You CANNOT generalize what is covered just by
saying, I have provider X.
Sarah, dx'92, pumping'00
.
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