In early March, I’m going to a 4-day diabetes clinic. You meet with docs & other specialists, and do a whole pile of education classes. The total bill will be close to $4K.
In theory, it’s all covered by my insurance. I’ve double checked that the providers are in the network, the services are covered in theory, etc. etc. My insurance will not pre-approve it. Or at least, that’s what they tell me. They say everything should be covered, but they have that very vague disclaimer that “everything must be medically necessary.” I can see them using that to refuse, well, just about everything.
I’m looking for any hints people can give me to up my chances of this being totally covered. Worst case, I’ll pay for it out of pocket, but I’d sure like to avoid that.
I’ve asked my doc here for a referral, which is not necessary according to my insurance, but I figure it can’t hurt. What do I do with it once I get it?
Michigan has a law that says that insurance companies have to cover diabetes education, supplies, medication, and all that, so that’s one thing on my side.
I have no answers for you. I’m having serious issues with our insurance company, which is Total Health Care, out of Michigan. We live in west central Indiana. My husband works out of Michigan. He’s an OTR truck driver. He is, as of today, quitting his job, because our health insurance won’t cover my Endo. here in Indiana, nor will it cover my ENT here in Indiana. It does cover our GP, but, she refuses to have anything to do with diabetes issues and ear problems, and sends me to a specialist for those things. For anything else, I must go to a doctor/specialist in Michigan. Our insurance doesn’t even cover either of our nearby hospitals. To go to the ER, I’d have to go almost an hour away, to a hospital that IS covered, but oddly, their doctors at that hospital are not covered. I can’t seem to wrap my little, bent mind around that issue. I just do not understand how they can do this shit.
I can only say that THC will not cover ANY of my diabetes supplies, and they told me that I had to use their brand of BG meter. When the pharmacist called the insurance company about it, they told him that the meter has been discontinued. That didn’t matter, because I have 3 meters, but they are One-Touch Ultra meters, but THC refuses to cover the test strips. They will not cover my syringes, insulin, nor will they cover my insulin pens. So, I’m stuck with the bottled insulin, when I can afford it. I am supposed to take 3 insulin injections each day, and test my BG 7 times a day. I have now been without insulin and BG testing for over 2 months. The insulins that they DO cover, do not work for me. My Endo has sent them letters concerning this. THC will NOT give in. So, I’m SOL at the moment.
I do wish you the very best of luck, though! You may need it!
Wow, what a horrible story! I hope your husband finds a job that provides better insurance!
I don’t think we’re going to have quite that level of headaches, because so far they haven’t turned down any of my doctor visits. Prescriptions, we’re not sure yet, we just filed the first ones - my insurance is a high deductible policy, which requires us to pay for prescriptions up front and once I hit the deductible they’ll reimburse me. Hopefully it won’t be an issue.