Here are some interesting facts about diabetes and insurance coverage:
- Diabetes is a life-long illness which, if not diagnosed and treated at the earliest, can cause health complications which can be fatal.
- It is possible to live a full and rich life with diabetes, provided you follow a careful and healthy diet, get your sugar levels tested frequently and follow the medication and treatment plan provided by your physician diligently.
- Most insurance companies (and this is not confined to the US alone) are reluctant to provide insurance coverage to diabetics, the illness is treated as a “pre-existing condition” and excluded from the policy coverage.
- Diabetes is an ‘expensive’ illness; insulin shots, diagnostic tests, medication, hospital visits, consultation fees, etc are regularly recurring expenses.
- A majority of the diabetic population is not in a position to fund the treatment on their own and with insurance companies shying away from providing coverage; it’s a lose-lose situation for patients.
The above information is not meant to imply that you cannot ever get insurance coverage for diabetes! Insurance cover is available, though the formalities involved are much more extensive, with a lot of riders and you definitely need to read the ‘fine print’ thoroughly. Read on to find out how to get affordable insurance coverage if you are a diabetic.
Options for securing coverage
- Check with your state’s Insurance Commissioner on the rules regarding denial of coverage. In some states, denial of coverage is an offence and insurance companies are prohibited from using pre-existing conditions as a reason for denial; other states have a “last resort” provision, where one provider is identified for insuring people who’ve been denied coverage by all the remaining providers in that state.
- Group health plans such as those provided by your company are another option. Insurance carriers who provide such schemes cannot refuse to enroll you in the plan if you’ve been diagnosed with diabetes. Other private entities which provide group health insurance include profession-based guilds or associations, unions, cooperative societies, etc.
- If you are already insured under the state-owned Medicaid program or are uninsured because private health insurance is unaffordable, check with the local administration as to the kind of coverage you can get as a diabetic.
- The American Diabetes Association (ADA) has a lot of comprehensive information on how you can get insurance coverage for diabetes. Check out the ADA website for further information.
What is included in coverage?
- Under a group health plan, the insurance company can set an ‘exclusion’ period, during which expenses for diabetes care will not be covered. As per federal law this exclusion period cannot exceed twelve months.
- Check which doctors, hospitals/clinics and pharmacies are covered under your plan. Also whether referrals to other specialists will be paid for.
- Get an idea of which specific medicines, devices such as syringes, pumps, glucose monitors, etc, including which specific brands are covered under your policy. You also need to know which tests and how many of these tests (a regular occurrence for diabetics), are covered under the plan.
- Tally up all the expenses you expect to incur in the course of one year and compare it against the amount covered under your insurance plan to get an estimate of your additional out-of-pocket expenses.
As you can see, getting insurance coverage for diabetics is difficult and complicated, but certainly not impossible. Explore all means and ways to find out how you can get adequate insurance cover to manage and live your life as a diabetic.