Ask Joslin: Insurance Questions

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What questions should I ask my insurance company about diabetes coverage?

Diabetic supplies and co-pays for appointments and prescriptions are probably the areas that cost people with diabetes the most. When shopping around for insurance it’s important to check with the insurance company about their prescription coverage for blood glucose strips and insulin. Is there a cap on how much is reimbursed per year for prescriptions or a limit on how many blood glucose strips they will cover on a monthly basis? What types of supplies are covered under the durable medical equipment (DME) coverage?

For pump users, ask whether pump supplies are covered under DME at 80 percent or 100 percent? Does the insurer cover continuous glucose monitoring and under what conditions? What are the copays for specialists and for routine office visits? Are visits for diabetes self-management or medical nutrition therapy covered and is there a yearly limit on the number of visits? Do the specialists you currently see accept the insurance plan? Is there a high deductible? Once the deductible is met, what happens to your co-pays? Someone with diabetes should think about what costs them the most and then ask about those particular items when talking to the insurance company.

3 Responses to Ask Joslin: Insurance Questions

  1. Elizabeth Davila says:

    I found that using prescriptions by mail is somewhat cheaper then buying them at the pharmacy. I think it would be a whole lot less expensive if my insurances covered the pump I was using instead of me having to purchase two types of insulin and needles or syringes. I have no idea what they are thinking they insisted on a 700 dollar deductible paid up front before i could have my pods, i had to go back to using syringes. One day soon i’m hoping not to have to use anything. I’ve been a diabetic for 44 years and can’t wait till i no longer have to use anything.

  2. James McAvoy says:

    I am a Type 1 diabetic – almost 40 years – now on Medicare. As far as I have been able to determine Medicare does not cover Continuous Glucose Monitors. Does anyone have any information to the contrary, or, about whether Medicare is likely to change this policy.

    • Nora Saul, Nutrition Manager says:

      Dear Mr. McAvoy:
      You are correct, at this time Medicare itself does not pay for continuous glucose monitors. We can hope that this will change in the future.

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