[Previous Months][Date Index][Thread Index][Join - Register][Login]   Help@Insulin-Pumpers.org
  [Message Prev][Message Next][Thread Prev][Thread Next]   for subscribe/unsubscribe assistance

RE: [IP] medical office lack of knowledge

Hi Joy,

[Insurance distinguishing between T1 and T2]

 > Did I hear right a few mins ago that
 > someone's T2 husband "isn't allowed"
 > to go to the endo? They can't do that!

Yes, they can. That's the point of HMOs: To have a "gatekeeper"
keeping costs down. You may not like it, but ....

Aside from that, there are major differences between T2IDDM and
T1IDDM -- major enough that I wish I were a T2. Even in a T2 with
no beta cells left whatsoever and a C-peptide of 0.0, management
is _generally_ easier.

For instance, the typical T2 diabetic is far more resilient in the
face of lows and highs; he does not generally go into DKA but into
a non-ketotic hyper-osmolar coma (NKHOC), and that happens much
later than DKA in a T1. (On the downside, once he is in a
full-blown NKHOC, the morbidity and mortality are significantly
worse than the outlook for a DKA patient.)

Anyway, there are differences, and depending on state and
contract, insurance may very well refuse to pay for some treatment
options unless medical necessity is shown. The thing that
surprises me about Kaiser is not that a T2 cannot see a
paid-for-by-Kaiser endo without a referral; it is that Kaiser
actually lets T1s see an endo without going through the GP first.
For Kaiser, this seems like a major attack of generosity.

for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org