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Type 1 Diabetes Vs Health Insurance

Type 1 Diabetes Vs Health Insurance

Recently, when doing an end-of-year bill-paying sweep, I realized we had won a fight with our health insurance over paying for Bisi’s diabetes care. The fight had been going on for so long that I had pushed it to the back of my mind and forgotten about it. Hearing about other people’s fights with their health insurance is not that interesting. But I suspect many people with T1D in their families have waged or will wage similar battles. So I’d like to pass along what worked for us. It all started with the pump education appointments required when Bisi selected and started on the Omnipod. The endocrinology program at the pediatric hospital where she’s seen requires everyone starting on a pump to go to a class to check out the different pumps, and then to 3 start up appointments to learn how to use the pump (one of them a required visit with a nutritionist). Our insurance covered the Omnipod, so I was surprised and confused when we started getting bills for these four appointments—adding up to $3,000. (Getting all these unexpected bills around Christmas-time was an unwelcome surprise.) What I learned from multiple calls to my husband’s company benefits administrator, our insurance company, the hospital billing department, and her endocrinologist’s office, and from reading through the text of our insurance policy, was that these appointments (in fact, all of Bisi’s diabetes appointments with her nurse educator) had been coded as “nutritional counseling”—and my husband’s insurance only covered three nutritional counseling visits a year Here’s part of what I wrote in my first appeal, which was rejected. “These three appointments [I focused on the pump start up appointments] were essential training sessions where Bisi’s diabetes nurse educator in Continue reading >>

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage State Laws and Programs Diabetes Health Coverage: State Laws and Programs This is a policymaker and consumer guide to state insurance mandated coverage, Medicaid coverage and state-sponsored diabetes programs. It was published 2011and updated material was added January 2016 All state law diabetes mandates and minimum coverage requirements for state-regulated health insurance policies. The tables include the enacted state laws passedsince the firstmandates inCalifornia (1981) and New York (1993). Use links below to go directly to state-based information: State Medicaid diabetes coverage terms and conditions. All Children's Health Insurance Program (CHIP) diabetes coverage. Contact information and an overview of federal funding provided by the Centers for Disease Control and Prevention (CDC) to state-sponsored diabetes prevention and control programs (DPCPs). DPCPs represent the front line in battling diabetes in most states. An overview of other state activities and initiatives, such as creation of diabetes coordinator positions in the executive branch to fight diabetes. Federal Health Reform.The federal Affordable Care Act (ACA) signed March 2010, has led to changed and expanded coverage termed "EssentialHealth Benefits." Newly Released: NCSL Survey:Diabetes Drug coverage: A new survey of2016 Insurance Plans in 50 states, examining 1) patient access to the scores of diabetes drug treatments and2) results in the 46 states with laws mandating or offering diabetes coverage. NCSL original research, published summer 2016. [Read the report] December 2015: " Diabetes: Addressing the Costs; A 50-State Budget Survey for FY 2014 ." NCSL released its latest diabetes report, taking a closer look at programs and budget appropriations that play a role in con Continue reading >>

This Is What Happens When People With Diabetes Lose Medicaid

This Is What Happens When People With Diabetes Lose Medicaid

In 2003, Jose Sanchez was a recent graduate just starting out in the world, hustling to get his graphic design business off the ground. Then, one day, his life changed. “I went to take a nap and then I didn’t wake up for two days,” he said. “When I woke up, I looked like the Matrix. I had all these tubes coming out of me.” Sanchez discovered he had Type 1 diabetes only after he had fallen into diabetic ketoacidosis, a life-threatening condition. His story is a reminder of what many diabetics went through in the years before the Affordable Care Act, and what many could face again if it’s rolled back. Because he had very little income at the time, Sanchez was able to qualify for New York State’s Medicaid program. Between changing his diet and lifestyle and getting insulin and other health care through Medicaid, he managed to stay relatively healthy after the incident. Eventually, he found stable employment and had a son. But then another disaster hit. In 2007, he learned that his job—working nights at Abercrombie & Fitch, prepping the store for the morning crowds—paid just a little too much for him to continue to qualify for Medicaid. “That’s when I found out the true cost of being a diabetic,” he said. Without insurance, insulinrefillsalone cost him $225 every three weeks. Diapers, food and milk for his son came first, so he rationed the medication and ended up in the emergency room over and over again, racking up tens of thousands of dollars in medical bills he had no way to pay on his salary. “I would end up being in the hospital for a weeklong visit as they brought my levels back down,” he said. “This just became routine. Once or twice I had to have the ambulance come and get me at my house.” For a lot of people like Sanchez, the expans Continue reading >>

Life With Diabetes Is Sweeter Thanks To Obamacare

Life With Diabetes Is Sweeter Thanks To Obamacare

Home | Blog | 2016 | 01 | 20 | Life with diabetes is sweeter thanks to Obamacare Life with diabetes is sweeter thanks to Obamacare ACA delivers consistent access to quality care and that makes a world of difference in managing and preventing the chronic condition Writer, communications strategist specializing in healthcare, issue advocacy When Alexander Star was 15 years old, he thought he was the picture of health, especially after he made the varsity basketball team. But when he told one of his teachers he needed to go to the bathroom every 10 minutes, she rightly told him he should be checked for diabetes. Frequent urination is a classic warning sign. When the doctors tested Stars blood glucose level, it was 1,300 mg/dL dangerously high considering that even in people with diabetes the goal is to keep blood glucose levels between about 100 and 150 mg/dL. The doctors wondered why I wasnt in a coma, says Star, who is now a 29-year-old recording artist/songwriter living in Florida. That was the beginning of my journey as a type 1 diabetic. He started taking better care of his health, which includes eating right, as well as taking insulin and checking his blood glucose levels multiple times a day, a regimen that can get expensive. He was covered under his fathers insurance plan until he turned 26 when he suddenly found himself without health insurance he could afford. The COBRA plan I was on shot up from $120 a month to $512 a month for the exact same plan, a cost that was not do-able for me, Star says. Fortunately, the Obamacare marketplace opened up soon after and he enrolled in a new plan. If it wasnt for Obamacare, I dont know how Id be capable of taking care of myself, Star says. Even if I had a lot of money, before Obamacare they could still decline me because I h Continue reading >>

How To Choose The Best Health Insurance Plan For People With Type 1 Diabetes: Key Questions To Ask

How To Choose The Best Health Insurance Plan For People With Type 1 Diabetes: Key Questions To Ask

How to Choose The Best Health Insurance Plan for People with Type 1 Diabetes: Key Questions to Ask Living with type 1 diabetes (T1D) means that having health insurance, and understanding how it works for you, is critical. Whether you are newly diagnosed, moving off your parents policy, choosing a new plan or experiencing a change in coverage, JDRF is committed to supporting you by providing tools to help you navigate healthcare and health insurance. When it comes to health insurance for people with T1D, it can seem like decisions are made without a clear reason, and they can surprise you. Our goal is to save you time and lower your frustration by sharing clear information to illustrate what is going on behind the curtain. We also aim to help you minimize the time and energy you spend trying to understand your coverage options, and to help you be prepared when working through issues you may experience. Here, well provide information on several key areas to consider as you select and then use your health insurance plan. Is there information readily available on how to submit an appeal if needed? If you are starting a new job, going into an open enrollment period or experiencing another change in health insurance, you may have more than one choice. Choosing the best health insurance plan for your diabetes can seem overwhelming, but we will help break it down one step at a time. One thing to note is that timing is important when dealing with insurance. Knowing the important dates will help you be successful. The time of year youre able to buy a plan can vary. If you have health insurance through your employer, talk to your human resources manager about your open enrollment dates, which are typically in the last few months of the year. If you are eligible for Medicare, that Continue reading >>

Health Insurance For Diabetics | Medsave.com

Health Insurance For Diabetics | Medsave.com

TN | July 1, 2004 Diabetics are challenged with the duel problem of having high out-of-pocketmedical cost and at the same time being denied eligibility to many low costhealth insurance plans. To make the problem even worse, the complications ofdiabetes make it less likely that a patient would be employed on a full-timebasis and eligible for group insurance benefits. Diabetics face additionalfinancial challenges aside than finding health insurance. Diabetics arestatistically likely to have a lower income and are more likely to suffer from arange of other social and economic stresses as compared with non-diabetics.Fortunately, all diabetics have access to at least one type of health insuranceand in most case two or more types of policies can be combined to improveoverall coverage. Insurance coverage is often so expensive as to impair a diabetic's lifestyle andso many elect to be uninsured. In addition, insurance for diabetics is sometimes so difficult to find thatmany individuals conclude that insurance is unavailable. Average medical costsfor a diabetic are currently $22,000 per year, or about 13 times more than theamount of a person without a chronic health condition. Obviously the huge medical costs of treating diabetes could not possibly be directly reflected in the individual insurance rates. If insurance actuaries applied standard medical risk undwriting principles to the pricing of individual insurance for diabetics, the insurance premium rate would exceed the total net income of a majority of diabetics! Instead, medical costs for treating diabetes are absorbed using two methods: 1) costs are re-allocated to the insurance prices of non-diabetics to the extend allowed by law (which means that the premiums for health insurance that cover diabetics are significantly Continue reading >>

How I Survived 4 Years Without Health Insurance With Type 1 Diabetes

How I Survived 4 Years Without Health Insurance With Type 1 Diabetes

From June 2008 (when I graduated college) to March 2012 (when I left the personal training business), I was completely uninsured. Working as a personal trainer often means that you’re an employee but you don’t get any benefits. You get a W2 for your taxes, but you don’t get paid vacation time, sick days, or health insurance. It wasn’t until my last six months as a personal trainer that they started offering health insurance at the biggest fitness chain in Vermont, but you only qualified if you worked X amount of hours per week, and they didn’t count hours spent doing new member consults (which they needed me to do), which is half of what all my 35 hours each week were spent doing. Building a full week’s worth of personal training isn’t easy, and many trainers have second or third jobs or they quit after 6 months because they aren’t making enough money–it’s tough, and every client you do have, you worked hard to acquire and maintain. I had been making a decent living for myself, but when it came to insurance, I was screwed. I couldn’t get state insurance because of my job at the gym and my income being well over 20K, and getting my own private insurance plan would cost over $600 a month with a $5000 deductible that wouldn’t even cover diabetes supplies for the first year because I’d been uninsured for more than 3 months. This really isn’t a guide or a how-to or tips for surviving without insurance, because honestly, it feels like it was total luck that I was able to get by without health insurance while living with type 1 diabetes. I need 2-3 bottles of inulin per month + approximately 200 strips per month + syringes and lancets. When you add that up at full cost, it’s well over $600 per month to keep myself safely and healthfully alive. The Continue reading >>

Health Insurance Coverage Among People With And Without Diabetes In The U.s. Adult Population

Health Insurance Coverage Among People With And Without Diabetes In The U.s. Adult Population

OBJECTIVE To compare health insurance coverage and type of coverage for adults with and without diabetes. RESEARCH DESIGN AND METHODS The data used were from 2,704 adults who self-reported diabetes and 25,008 adults without reported diabetes in the 2009 National Health Interview Survey. Participants reported on their current type of health insurance coverage, demographic information, diabetes-related factors, and comorbidities. If uninsured, participants reported reasons for not having health insurance. RESULTS Among all adults with diabetes, 90% had some form of health insurance coverage, including 85% of people 18–64 years of age and ∼100% of people ≥65 years of age; 81% of people without diabetes had some type of coverage (vs. diabetes, P < 0.0001), including 78% of people 18–64 years of age and 99% of people ≥65 years of age. More adults 18–64 years of age with diabetes had Medicare coverage (14% vs. no diabetes, 3%; P < 0.0001); fewer people with diabetes had private insurance (58% vs. no diabetes, 66%; P < 0.0001). People 18–64 years of age with diabetes more often had two health insurance sources compared with people without diabetes (13 vs. 5%, P < 0.0001). The most common private plan was a preferred provider organization (PPO) followed by a health maintenance organization/independent practice organization (HMO/IPA) plan regardless of diabetes status. For participants 18–64 years of age, high health insurance cost was the most common reason for not having coverage. CONCLUSIONS Two million adults <65 years of age with diabetes had no health insurance coverage, which has considerable public health and economic impact. Health care reform should work toward ensuring that people with diabetes have coverage for routine care. The number of adults in th Continue reading >>

Type 1 Diabetes [en Español]

Type 1 Diabetes [en Español]

Topic Overview Is this topic for you? This topic covers type 1 diabetes, including information about symptoms, tests, and home treatment. For specific information about children who have type 1 diabetes, see the topic Type 1 Diabetes: Children Living With the Disease . What is type 1 diabetes? Insulin is a hormone that helps the body's cells use sugar (glucose) for energy. It also helps the body store extra energy in muscle, fat, and liver cells. Without insulin, this sugar can't get into your cells to do its work. It stays in your blood instead. And then your blood sugar level gets too high. High blood sugar can harm many parts of the body , such as the eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications). Type 1 diabetes can occur at any age, but it usually starts in children or young adults. That's why it used to be called juvenile diabetes. Type 1 diabetes is different from type 2 diabetes. In type 1 diabetes, the body stops making insulin. In type 2, the body can't use insulin the right way. Over time with type 2, the body doesn't make enough insulin. There isn't a cure for type 1 diabetes. But with treatment, people can live long and healthy lives. What causes type 1 diabetes? The body makes insulin in beta cells, which are in a part of the pancreas called the islet (say "EYE-let") tissue. Type 1 diabetes starts because the body destroys those beta cells. Experts don't know why this happens. Some people have a greater chance of getting type 1 diabetes because they have a parent, brother, or sister who has it. But most people with the illness don't have a family history. Other things that increase the risk of getting type 1 diabetes are being white and having islet cell antibodies in the blood. Wh Continue reading >>

The Health Insurance Marketplace & People With Diabetes

The Health Insurance Marketplace & People With Diabetes

The Health Insurance Marketplace & People with Diabetes The Health Insurance Marketplaces are open for business! Despite federal efforts this year to change the Affordable Care Act, you can still buy health insurance through your state Health Insurance Marketplace and financial help to lower monthly premiums and out of pocket costs is still available. But you must act soon: Open Enrollment begins November 1, 2017 and ends December 15, 2017. (Some states may allow more time to enroll after December 15- check with your state Health Insurance Marketplace). Individuals and families can buy health insurance through a Health Insurance Marketplace (Marketplace) available in every state. Starting in 2014, all new health insurance plans, whether sold inside or outside the Marketplace, cannot deny coverage, charge more, or refuse to cover treatments because you or someone in your family has diabetes. People who meet certain income requirements may also qualify for help paying their premiums and other costs for plans purchased in the Marketplace. A Health Insurance Marketplace is a way for individuals, families, and small businesses to shop for and compare various private health insurance options all in one place. Plans offered in the Marketplace must meet certain requirements for benefits, consumer protections, and cost to the consumer. Marketplace plans are separated into four different categories: Bronze, Silver, Gold, and Platinum. These categories are based on an average of how much the plan pays for covered benefits. In general, moving from Bronze to Platinum, out of pocket costs get lower while premiums tend to get higher. Who Can Buy Health Coverage in a Marketplace? Generally, anyone who buys health insurance on their own can buy it through a Marketplace. However, only t Continue reading >>

Getting Health Insurance With Pre-existing Diabetes

Getting Health Insurance With Pre-existing Diabetes

We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Can't get insurance coverage because of a pre-existing medical condition... like say, diabetes? A new temporary federal program allows PWDs and others to buy individual health insurance, at least for the next few years. By D'Mine Columnist / Correspondent Wil Dubois Until very recently, the health insurance industry commonly referred to type 1 diabetes as an "automatic denial" condition. In many states it simply wasn't possible for T1s to buy individual health insurance for any amount of money. In states where you could, the insurance company could legally include a rider denying coverage for anything related to your diabetes. So you could get health insurance; for everything but your diabetes. And they could legally charge you more, too. Lots more. In recent years, type 2s, especially those requiring insulin, also found individual insurance either prohibitively expensive or flat-out unavailable. As have folks with cancer, HIV/AIDS, and even asthma. Basically, if you needed health insurance, they wouldn't sell it to you. This institutionalized prejudice is scheduled to be outlawed in 2014 when the 974-page Affordable Care Act fully rolls out. Assuming that the massive health insurance reform law survives legal challenges and threats of repeal, everyone in the country will be required to purchase health insurance; and the health insurance companies will no longer be allowed to deny anyone coverage. The infamous "pre-existing condition" will go the way of the dodo bird; as will be the ability of a health plan to charge you more if you are "sick." Today, however, people suffering from a wide range of conditions can still b Continue reading >>

What Health Insurance Is Best For A Type 1 (t1) Diabetic With Insulin Pump (omnipod) - Diabetes

What Health Insurance Is Best For A Type 1 (t1) Diabetic With Insulin Pump (omnipod) - Diabetes

What health insurance is best for a Type 1 (T1) diabetic with insulin pump (OmniPod) I recently was dropped from my parent's health insurance because I just turned 23. I was wondering if anyone had recommendations for health insurance plans that have low premiums or cover Omnipod supplies under co-pays. Under my old health insurance my Omnipod supplies (i.e. Pods) went from being covered under co-pays to me being responsible for 20% of the cost which I get charged almost $100/box. I really like being on the Omnipod but those costs add up. So I wanted to hear some recommendations from Type-1's who like their health insurance plans and are using a insulin pump, specifically the Omnipod. I am new to this and I want to make the right decision for my health insurance. I also want to avoid being charge too much. Any suggestions? I'm on Anthem and it's been pretty good so far. Word of advice: be very careful about the pre-existing condition coverage. I know obamacare was supposed to do away with health insurances denying coverage for pre-existing conditions, but the reality is that there are a LOT of plans that are "grandfathered" in, meaning they existed before obamacare, so they're allowed to not follow obamacare rules. It's very confusing to keep track of. I'm not familiar with the experience of "shopping around" for health insurance so honestly I can't give you too much advice, just be careful to read EVERYTHING and don't make any assumptions. There's a lot of confusing information and mis-information out there. Even well intentioned people can be wrong. Agreed - I believe you can stay on until 26. I'm surprised you qualify for ACA subsidy if your employer offers health insurance. My understanding was that if your employer offered health insurance (even if practically una Continue reading >>

Health Insurance For Diabetics

Health Insurance For Diabetics

Empowering diabetics to take control of their health by Tony Novak, CPA, MBA, MT, updated 2/19/2013 Resources are listed on a state-by-state basis: Jump to listings of health plans for diabetics The video overview of "health insurance for diabetics" by OnlineAdviser Tony Novak was removed February 19, 2013 following the halt of the PCIP health plan that was a core part of the recording. A replacement video will be recorded soon. Financing the care of diabetics has become the most challenging task of U.S. public and private insurance plans. The Center of Disease Control estimates that 24 million Americans have diabetes and that the disease is now the 7th leading cause of death in the United States. An additional 57 million have pre-diabetes. In about 60% of cases, diabetes is also associated with obesity. From a health insurance standpoint, the need for expensive and often lifelong care make diabetes an overwhelming cost driver. Diabetics have medical expenditures more than twice as high as those who do not have diabetes, with total annual health care costs for a person with diabetes topping $11,744 in 2007 according to the American Diabetes Association.The out-of-pocket costs (expenses not paid by insurance) for treating diabetes is reported to average about $350 per month. A study reported in the February 15, 2013 issue of Diabetes Care triggered an increase in fears among medical professionals that the health care system may be overwhelmed with younger, sicker people with serious diabetes complications, especially Type 2 diabetes. While both the number of patients and the costs of treating each diabetic continue to climb, insurance premium payers increasingly resist paying for what they view are a lifestyle management issue rather than acute medical care. Under the c Continue reading >>

Tips For Buying Health Insurance

Tips For Buying Health Insurance

No insurance company is eager to insure the health of people with diabetes. In fact, they do so only when forced by competition or political dictate. Whenever possible, insurance companies attach restrictive diabetes riders, exclusions, and waiting periods to limit or eliminate their financial exposure. Who can blame them? People with diabetes have more frequent and extensive medical claims than the general population. Its not the costs of insulin, syringes, or blood tests that alarm insurance carriers. Rather, its a persons long-term risk for serious diabetic complications such as blindness, cuts that wont heal, or circulatory problems that can be hazardous to an insurance companys financial health. While a person with diabetes in his 20s or 30s may be as claim-free as any other healthy person that age, the prospect of future medical problems is more than just a possibility; its a probability. And since insurance companies deal in probability, people with diabetes represent potentially devastating financial losses. Even under the best of circumstances, its not easy for an insurance company to earn a profit from medical insurance. Hospital beds that not so long ago rented for $50 a night now cost thousands, miracle drugs priced at $100 a pill are commonplace, a simple appendectomy costs several thousand dollars, and theres no end to this trend in sight. Insuring people with diabetes only adds to a companys problems. Along with the escalation of medical costs, adverse federal and state mandates have caused hundreds of commercial insurance carriers to leave the marketplace altogether. What remains is a sellers market in which the consumer has very little room to negotiate. The few companies that continue to underwrite medical coverage are very selective as to whom they w Continue reading >>

The Ultimate Health Insurance Guide For Individuals With Diabetes

The Ultimate Health Insurance Guide For Individuals With Diabetes

Diabetes is a disease that requires a lot of self-management along with the help of various medical equipment and medication such as blood glucose monitor, test strips , insulin, and syringes. Without any health insurance coverage, it will almost be impossible to receive sufficient treatment to manage the symptoms and prevent complications from arising. Although individuals with pre-existing conditions have difficulties getting health insurance coverage in the past, the recent health care reform has significantly made the process much easier for diabetes patients to obtain a policy and receive proper health care. If you have recently been diagnosed with diabetes and/or need to subscribe to a new health insurance policy, this article will give you a wide series of information that will be of help: Health Insurance 101: What is Health Insurance? Health insurance is a form of insurance that provides coverage for an individual who requires medical treatment and/or management. Depending on what type of policy the individual has chosen, the insurance company will either make direct payment to the health provider or reimburse the individual after the payment. When you are reading about health insurance information , you will come across two commonly used terms: provider and insured. The term health provider includes any facilities or professionals that provide health care to the individuals; in other words, health provider can be a hospital, a clinic, an emergency clinic, a doctor, a laboratory facility, a pharmacy, and any health care practitioners. The term insured is the subscriber of the health insurance policy that means you. Coinsurance: It is the percentage of costs you are required to pay for your covered services after you have paid your deductible. Copayment: It is Continue reading >>

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