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From Old Bridge, New Jersey, USA:

My four and one-half year old son was diagnosed with type 1 diabetes at the beginning of this year. My doctor advised me to get his eyes checked. Unfortunately, I called my medical insurance and they told me that this is not covered with our plan. I know that my son need this check-up because he squints a lot. Is there anything that I can do or tell my insurance that this eye check- up is a part of his medical requirements?


A four year old does not need an eye checkup for diabetes. He needs this after three to five years of diabetes. We do recommend that children over 10 who develop diabetes get the check, actually puberty, but I choose 10 since it's a hard number. Diabetic retinopathy isn't a problem yet. Unless you do very tedious and invasive tests, you can't see changes in a four year old, especially at diagnosis. The squinting may be something else, do see someone, insurance is a contract and yours may not pay for everything.


[Editor's comment: It may be that your insurance does not cover routine eye exams by an optometrist. You might try asking your son's pediatrician for a referral to a pediatric ophthalmologist in your insurance network. The referral should state that your son has diabetes and seems to be having some vision difficulties. If your son's blood sugars are running high, he may be experiencing blurry vision which might resolve with improved control. SS]

Original posting 5 Jan 2001
Posted to Social Issues: Insurance/Costs


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