My insurance company wants me to get diabetes

[Skammer]

Okay, no, they really probably don't.

But, I've been diagnosed with heel spurs. Nice big ones. In both feet. Throughout the day the pain ranges from "somewhat uncomfortable" to "extremely painful" depending on how much I've been standing and what footwear I'm wearing.

My foot doctor recommended some stiff orthotic shoe inserts, which would provide support and stability for my feet. This should reduce the pain and prevent the spurs from getting worse. Without insurance, these will cost me $350-$400 dollars.

With insurance, they will cost me ... the same. Because my insurance company has informed me that they only cover orthotics if they are to treat complications related to diabetes, or are part of a leg brace.

Now, I've been fighting my genetics to avoid diabetes, but if it's the only way to be able to stand for any length of time without pain...

They will, however, (probably) cover surgery. So they won't pay $400 for shoe inserts but they will pay thousands of dollars for surgery, crutches, etc. Doesn't make much sense to me.

[Wilbo523]

Why do you feel that your insurance coverage should pay for whatever you don't want to?

Just pay for the orthotic devices out of your pocket, and not make stupid arguments about getting diabetes so that they are covered or having an uneccesary surgery that will be covered. It's only $350. For you to switch to an insurer that would cover such things would cost you more than that in premiums.

[Swallowed My Cellphone]

Originally Posted by Wilbo523

Why do you feel that your insurance coverage should pay for whatever you don't want to?

The OP seems to be highlight the disconnect that the insurers will not contribute for something that could easily prevent a surgery that would cost ten times that. Plus, is lamenting the fact that most benefits packages (at least that I've ever heard of) does cover a portion of orthodics when there is a doctor's prescription, and therefore, the OP's insurer kind of sucks.

[Scarlett67]

Originally Posted by Wilbo523

Why do you feel that your insurance coverage should pay for whatever you don't want to?

The way I see it, this is the stupid part:

Originally Posted by Skammer

They will, however, (probably) cover surgery. So they won't pay $400 for shoe inserts but they will pay thousands of dollars for surgery, crutches, etc. Doesn't make much sense to me.

It's like insurers (fortunately not mine) that won't cover birth control, but will cover maternity costs and insurance on a kid for 18 years. Guess which is cheaper?

[Wheelz]

Originally Posted by Wilbo523

Why do you feel that your insurance coverage should pay for whatever you don't want to?

I'm guessing because it's his medical insurance that's refusing to pay for medical equipment to help treat a medical condition. Perhaps I'm just being too literal-minded.

[Wilbo523]

Originally Posted by Wheelz

I'm guessing because it's his medical insurance that's refusing to pay for medical equipment to help treat a medical condition. Perhaps I'm just being too literal-minded.

Well I guess if anything medical was covered under medical insurance, life would definitely be simpler, but typical insurance premiums would cost multiples of what they do today.

Alot of people I encounter that complain about their coverage, live under the impression that their medical insurance is a ticket past the gate to the magic medical money tree that's ever replinishing.

[Wilbo523]

Originally Posted by Swallowed My Cellphone

most benefits packages (at least that I've ever heard of) does cover a portion of orthodics when there is a doctor's prescription, and therefore, the OP's insurer kind of sucks.

Considering we don't know what the total costs of his insurance, it might be a hell of a deal.

[Mama Zappa]

Originally Posted by Skammer

...

They will, however, (probably) cover surgery. So they won't pay $400 for shoe inserts but they will pay thousands of dollars for surgery, crutches, etc. Doesn't make much sense to me.

Well, that's sort of silly!

I had something analogous happen 25ish years back. Sesamoiditis - which could be treated by steroid injections into the spot (did not respond at all to oral anti-inflammatories), or a more permanent cure would be orthotics. But the orthotics weren't covered.

I wound up appealing - and getting the orthotics partially covered. I explained to them they could keep paying for a doctor's appointment / injection every few month, or cover the orthotics. They asked for medical records and doctor comments, and wound up approving the orthotics.

Of course, this was subject to my deductible so only a fraction of the cost was covered. But it got me away from having to have shots (or continuing to walk in pain).

[FallenAngel]

I had a similar thing a few years ago. I'd asked my doc for a wellbutrin script to help me quit smoking. Insurance company came back and said they'd only cover it for psych issues. The doc's response: You idiots will pay for his lung cancer treatments but not for something to help him quit smoking so he doesn't get lung cancer?! That's $120, vs. $500,000. Aren't you guys supposed to be good at math or something?

[Skammer]

Originally Posted by Wilbo523

Why do you feel that your insurance coverage should pay for whatever you don't want to?

Just pay for the orthotic devices out of your pocket, and not make stupid arguments about getting diabetes so that they are covered or having an uneccesary surgery that will be covered. It's only $350. For you to switch to an insurer that would cover such things would cost you more than that in premiums.

I don't think this is a frivilous claim. It's not "routine foot care" which, rightly, is not covered by my plan. This is more like "durable medical equipment" that 1) would improve my quality of life (allowing me to stand and walk without pain) and 2) avoid surgery with its associated costs and risks.

Yes, I think it would be nice (and make sense business-wise) for my insurance company to cover it.

Originally Posted by Wheelz

I'm guessing because it's his medical insurance that's refusing to pay for medical equipment to help treat a medical condition. Perhaps I'm just being too literal-minded.

Right; if I wanted to pay medical expenses out of my pocket, I wouldn't bother with insurance, would I?

I should also disclose that I work in the benefits department of a Fortune 500 company. I'm familiar with the issues of healthcare. I just think this particular exclusion kind of stinks because it provides negative motivation: I can save several hundred dollars by getting diabetes or surgery instead of treating my condition before it gets worse.

[Wilbo523]

Originally Posted by Skammer

I can save several hundred dollars by getting diabetes or surgery instead of treating my condition before it gets worse.

Since you put it this way, by all means, please contract diabetes or have a surgical procedure done to save yourself a few hundred dollars.

[Skammer]

Thanks, I'm actually leaning towards the surgery.

[tdn]

Skammer, I know you've probably already been through this with your doctor and everything, but why not just get the surgery? Your insurance company will pay for it, and you'll get to choose footwear for style rather than pain relief. Win/win. And you'll be directly addressing the problem rather than merely cushioning it.

[tdn]

Originally Posted by Skammer

Thanks, I'm actually leaning towards the surgery.

Oops, simulpost.

[D_Odds]

Originally Posted by FallenAngel

I had a similar thing a few years ago. I'd asked my doc for a wellbutrin script to help me quit smoking. Insurance company came back and said they'd only cover it for psych issues. The doc's response: You idiots will pay for his lung cancer treatments but not for something to help him quit smoking so he doesn't get lung cancer?! That's $120, vs. $500,000. Aren't you guys supposed to be good at math or something?

In theory, they are very good at math. If they deny 500 wellbutrin scrips and only one of the denied actually gets a tobacco-related illness, they're ahead. And someone at the insurance company is responsible for calculating these odds.

[Wilbo523]

Originally Posted by Skammer

Thanks, I'm actually leaning towards the surgery.

How much is your deductible? Is it fully met already for this plan year? Do you have % co-pay's for the surgeon, hospital, etc., etc.? Need to check all of that out before you make the decision. Those types of items could run you some serious $$$.

[Skammer]

Originally Posted by Wilbo523

How much is your deductible? Is it fully met already for this plan year? Do you have % co-pay's for the surgeon, hospital, etc., etc.? Need to check all of that out before you make the decision. Those types of items could run you some serious $$$.

I've met the deductible, but you're right I need to calculate my co-pay and take into account I will actually need two separate operations done six weeks apart. I think it's outpatient but there will still be costs that will probably exceed the cost of orthotics. But it's also a more permanent solution.

[AboutAsWeirdAsYouCanGet]

Oh GAWD.... That's like my parent's insurance which wouldn't pay for hearing aids (VERY EXPENSIVE) but would pay for a hit and miss (some people throw away their hearing aids but the results are very mixed) canalplasty surgery. (surgery to create an ear canal that wasn't there in the first place)

[Not a Platypus]

I haven't figured out why diabetes-related expenses are frequently covered so much more than other issues. Like my current insurance plan doesn't cover durable medical equipment at all, unless it's for diabetes. I don't understand the logic, and it's frustrating having to pay full price for supplies that I NEED every month for a disorder that severely fucks with my life and health if I don't treat.

[Eonwe]

Originally Posted by Wilbo523

Well I guess if anything medical was covered under medical insurance, life would definitely be simpler, but typical insurance premiums would cost multiples of what they do today.

Alot of people I encounter that complain about their coverage, live under the impression that their medical insurance is a ticket past the gate to the magic medical money tree that's ever replinishing.

I just tried to have this discussion with someone else on the board just a week or so ago.

The issue is not "insurance should pay for whatever I want it to." The issue is "seemingly arbitrary things that aren't covered, while alternative treatments that most definitely cost the insurance company more are covered."

Why will they pay for surgery, but not for orthotics? On the face of it it's ridiculous both from a patient care perspective and a cost-savings perspective.

[panache45]

I have diabetes and I don't have insurance. Count your blessings.

[needscoffee]

I would look into alternatives to new, custom orthotics. Does it have to be custom fitted to your foot? Will a generic drugstore insert work? A removable foot boot/cast cost me $150 at the podiatrist's, but I could have picked one up for a fraction of that at the drugstore or free on freecycle. My PCP just "gave" me a velcro strap to wrap around my arm for tendinitis, and I got a bill for $75 for the strap alone. Research the device he recommended and see what you can come up with. Have you tried a gel insert?

[Lynn Bodoni]

Originally Posted by Eonwe

I just tried to have this discussion with someone else on the board just a week or so ago.

The issue is not "insurance should pay for whatever I want it to." The issue is "seemingly arbitrary things that aren't covered, while alternative treatments that most definitely cost the insurance company more are covered."

Why will they pay for surgery, but not for orthotics? On the face of it it's ridiculous both from a patient care perspective and a cost-savings perspective.

This is what I can't figure out. Surely they don't sit around and think that if someone needs a problem fixed, paying for only the more expensive option is a GOOD thing?

[LurkMeister]

Some years ago I was looking for weight loss options and found out that my health insurance company would cover bariatric surgery but not appetite suppressant medication,which was much cheaper.