From Wellston, Oklahoma, USA:
Our health insurance provider refuses to pay for test strips for my daughter, saying she uses too many, but her endocrinologist says she needs 200 per month. She tests at least four times per day (morning, lunch, supper, and bedtime) and has four shots per day (at the same times as above). We also test when she feels low, which sometimes can be around time times per day, not counting sick days.
How can the insurance company question and even say no to the number of glucose test strips my daughter's doctor says is necessary? How can I give her a shot not knowing what her blood sugar is? Someone said they heard it was a Federal law that diabetic supplies had to be covered on your insurance. Do you know anything about it? Where can I go for help?
We are at our wits end. I did talk to Social Security about getting her classified as being legally disabled, but they said it wasn't automatic. If she had lost both of her feet, she would qualify automatically, but, if she had lost just one foot, they would have to consider it. My whole goal is to prevent her from losing her feet! Do you have any answers?
You have several options in fighting your insurance company's refusal to reimburse for an adequate number of testing strips. The first thing you must do is appeal the plan's decision using the grievance procedures established by your plan. You can find that information in your plan's benefit book. In making your appeal, make sure that you have your physician write a letter documenting why a greater number of daily blood glucose tests are required.
If your plan is governed by State law, and your appeal is denied by the health plan, you should file a complaint against your health plan with the state department of health and the department of insurance. Again, make sure that you have documentation from your physician as to why there needs to be frequent testing. Be aware that if you belong to a self-funded plan or ERISA plan, the State will have no enforcement authority over the decisions made by your health plan.
Original posting 18 Nov 2002
Posted to Insurance/Costs
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