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A problem that I have is that I have a $2,000 deductible. They encourage shopping around, which I did when I suspected sleep apnea. I actually went from initial sleep study to buying a CPAP machine for less than the $2,000 but they don't make it easy to account for all of my purchases to put them towards that deductible. I actually shopped around where "the system" wants you do work within the system. A better method of tracking these expenditures is needed. Reform needed.
Also, the $3,500 FSA limit needs to be raised. I spend mine by June usually. And why do you loose it if you don't spend it all? What's fair about that? Let me pay the tax on what remains.
Finally, the tax deductibility needs to be reworked rather than eliminating whatever it is now, something like 4.5% of your income or whatever. It kill a person who takes some 401K money to pay off medical bills, besides that damned penalties for doing so.
I don't want something for nothing, but the government could make the laws that exist now a whole lot friendlier to us before turning the country into turmoil with HR3200!
I totally concur with your comments. Health care Reform is needed desperately: I just hope in the end that the insurance companies are not the ones making all the medical decisions when it then becomes only a matter of the bottom line and NOT what is in the best interests of the patient. It is bad enough as it is now.
Good info - thanks. Anything more re typeII diabetes?
hi Beau: I wish I had more experience with type 2 diabetes. As a pediatrician, I do have young patients with type 2; but fortunately they do not develop complications until the are older (of course, I am hoping with good professional and self-care that they never do! ) However, if you have type 2 diabetes and are on insulin, the same criteria should be applied to you. If you are experiencing lows etc. they need to be documented and then the insurance medical evaluators have evidenced-based medicine requiring a decision. If you are experiencing sleep apnea, you would need to have that documented by a sleep study so that CPAP should be available based on your durable medical equipment allowance. It is tough: these insurance companies have so many loopholes. You also should ask your doc to call the medical director of the insurance company and do a "peer-to-peer" consultation on your behalf. I think the insurance companies know that setting up these appointments are incredibly inconvenient for the doctor and hope that they don't want to spend the time involved. But if we are persistent, sometimes we win. Sorry I don't have too much more information with type 2. Sadly, as more and more kids and teens develop type 2, I will get more experience.
I recently was told by Medicare that I have reached my maximum spending allowance of $2785.00. I have insurance which is a Medicare supplement, so what do I do until December to pay for my drugs? I pay $25.30 a month for this coverage, and I was told if I cancel I will be penalized by Medicare. I'm damn if I do or don't! Is their an insurance plan out there that isn't Medicare controlled? Thanks,
I live in Taos NM, and am caregiver for my 69 year old husband. I am 58.9 years old and my in surance is Lovelace STATE COVERAGE INSURANCE (SCI). BEFORE I SUBSCRIBED TO THIS INSURANCE FOR THE 1RST TIME LAST YEAR, I HAD 3 COMPANIES TO CHOOSE FROM AND LOVELACE SEEMED TO HAVE THE MOST TO OFFER. I CALLED THEM AND ASKED IF THE COVERED DIABETIC SHOES, COMPRESSION HOSEIRY, VISON CARE AND DENTAL CARE. I WAS LED TO BELIEVE THEY DID, BUT QUICKLY FOUND OUT ONCE I SIGNED UP THAT THEY HAD MADE DEALS WITH THE COMPOANIES THAT YOU GO TO TO GET THE DIABETICSHOES-THEY GACE THEM A NATIONWIDE CONTRACT TO COVER THE SHOES, BUT HANGER HAD TO AGREE NOT TO CHARGE MORE THAN $101.00 PER PAIR, AND THE 3 PAIRS OF INSERTS ARE $28.95 PER PAIR--THE SHOES ARE CONSIDERED DURABLE MEDICAL EQUIPMENT AND FOR US DURABLE MEDICAL EQUIPMENT HAS TO COST $200.00 OR MORE TO BE COVERED, SO IT IS A DISHONEST WAY THEY DO IT AS YOU CAN SEE. THEY WILL NOT PAY FOR COMPRESSION HOSEIRY FOR DIABETICS AS A PREVENTITIVE MEASURE(I HAVE CADIOVASCULAR INSUFFICIENCY IN MY LEGS AND FEET FROM WHEN I WEIGHED 312#'S AT 5'1" TALL--I WEIGH 148POUNDS NOW)-THEY WOULD PAY TO HAVE MY TOES, FEET, LEGS AMPUTATED, REHABILITAION THERAPY, PROSTHETICS AND PEOTHETIC SHOES, WHICH COST THOUSANDS OF DOLLARS, BUT NOT THE SHOES AND HOSEIRY TO PREVENT THE LOSS OF THE LIMBS. THIS IS $500.-$600.00 A YEAR COMPARED TO THOUSANDS OF DOLLARS OVER A LONG PERIOD OF TIME. THEY HAVE A VERY POOR VISION CARE PROGRAM. THEY HAVE NO DENTAL CARE--NOT EVEN PREVENTIVE DENTAL CARE, AND IT HAS BEEN PROVEN THAT DENTAL CARE IS IMPRTANT TO PREVENT HEART PROBLEMS AND SEPSIS (MY MOM DIED FROM SEPSIS FRPOM BAD TEETH IN A NURSING HOME AT 62 YEARS OF AGE IN 1994)hOW CAN AN INSURANCE SOMPANY GET AWAY WITH SAYING THEY PROVIDE THINGS THEY DON'T PROVIDE? i NEED A NEBULIZER AND IT TO IS COVERED SUPPOSEDLY UNDER DURABLE MEDICAL EQUIPMENT-NOT. WHAT CAN WE DO TO GET THESE INSURANCE COMPANIES TO GET MORE INVOLVED IN PREVENTATIVE CARE? IT IS ALOT CHEAPER THAN THE ALTERNATIVE IN THE LONG RUN.
I am sorry to hear how, once again, the insurance companies have chosen the path away from preventative medicine. I simply do not understand this way of thinking, either. One would think that there would be more cost savings by preventing the long term complications than by admitting to the hospital for major expensive treatment and procedures. To me: choosing preventative care to save $ in the future should be one of the first steps in health care reform along with accepting people with pre-existing conditions. Indeed, as a pediatrician, I think preventatively and work to avoid future problems. I am always fighting with insurance companies to cover DME etc and have to provide enormous amount of documentation in order to get their attention. As I said previously, the insurance companies count on the health care providers to give up because of the amount of time involved. I am hopeful that not all insurance companies are like this: some are better than others.
Thank You for your positive feed back. I plan on calling and emailing and snail mailing the insurance companies involved the comments you made. I feel the Insurance companies need to become more concerned about helping those patients like me and my husband who try our best to prevent problems as we can afford to and are compliant with diet, medications etc. get the things we ned like the Diabetic Shoes, Compression Hosiery and even better eye care and add dental coverage now that the medical fields are connecting Heart problems and Diabetes with bad teeth, because the way things now stand, one could die younger for lack of the provisions we have discussed. Maybe that is what they want?? I appreciate Doctors like you who stand behind this reasoning-Prevention ISWorth a Pound of Cure.
Star Shepherd
Dealing with the rising health care cost and a public option begins at home. Everyone ought to take personal responsibility to care for their health. As a diabetic for 40 years, I have to live an incredibly disciplined life, but that is OK because that is part of who I am. So people with simple problems like eating too much, exercising too little could be solved with no medical costs by living a smalrt life style. Cut the food and exercise more. I know this comment will make a whole lot of people defensive, saying my individual case is different. OK how many of you were walking skeletons and so weak you could not even walk 100 yards? How many of you puked and visited the bathroom often until provided insulin? Exactly, most people have it so easy compared to my life, yet I have an inner drive and discipline that allowed me to reverse everything. I could have paid a doctor $1 million dollars, but it was all up to me and not doctor with any kind of insight could do a thing for me. Only me can fix me.
My husband works for a very small business and we've paid more and more over the last several years for just medical insurance (no dental or eye plan). When our daughter was diagnosed almost 7 years ago, we tried to get some help paying for all of the extra expenses since our income was within the limits for state insurance, but we were denied. I've applied a few times since then just to see if she would be accepted. The last time, I read the letter more carefully and realized that we are still within the income limit to get insured for a small premium. They said they wouldn't insure her because we have private insurance (not that we can actually afford it; we just "do without" a lot of other things). I asked if I could pay the premium and she could just have the dental and eye and we wouldn't use them for the medical. They said that it's all one package and we couldn't do that. The thing I don't understand is why my daughter as a diabetic can't have dental and eye coverage just because we have medical insurance. They will give the complete package to people who have the same income as we do. I know the whole system is probably confusing for a reason, and people "work" the system all the time. I just want to be able to get my daughter the care she needs since she already had to get 4 teeth pulled when she was 7 yrs old since her teeth were so bad and we couldn't afford to do the other options. Do you have any advice? Maybe I need to use certain wording to get through red tape?
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This in an excellent topic, but I am wondering how many questions are left unanswered. This is also a topic that needs to be revisited on a regular basis and have the information updated as it is discovered that insurance companies are increasingly trying to exclude more expenses from coverage.
By that I mean, if the person with diabetes has associated problems, such as sleep apnea, become glycemic unaware (especially for type 1), develop neuropathy, heart problems, kidney problems, and eyesight problems, and even mental health. How far will insurance cover these expenses?
It is especially problematic for these that become glycemic unaware, i.e., do not have the symptoms that most type 2's have come to recognize when having a low or a high glycemic event. Will insurance pay for these extra expenses or if the person in fortunate to be able to obtain a diabetes alert dog, will insurance even consider. If the person is truly diagnosed a glycemic unaware, IRS still likes to challenge, but is generally allowing the expense as medical if properly diagnosed.
There are so many problems now associated with diabetes and people need to know what their medical insurance policy will and won't cover. Without insurance, medical expenses are indeed a burden.
Thank you for your comments. The only way I can ever get an insurance company to pay attention particularly for durable medical equipment is to document carefully why I want my patient to have it. As such, for patients that have hypoglycemic unawareness, I have to show it: I do this by either glucose logs or even better: continuous glucose sensor tracings. If you can document these lows without symptoms, you have a better chance for the insurance company to cover. Believe me, these insurance companies drive me crazy forcing me to jump through hoops to advocate for my patients and require me to spend tons of time on the phone with their medical directors.