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Do your patients know what's covered by their private insurance or Medicare?

Dec 09, 2011

I am continually amazed at the challenges our patients face when it comes to healthcare coverage. What stories do your patients tell about healthcare coverage and insurance?

Last week, I had a patient with diabetes who had a private insurance and Medicare. She told me that the mail order company she used told her that her diabetes testing supplies were not covered. She said she has been paying the full amount and there was just no way that she could afford another month because she has a very limited income. I asked her if the mail order company had her insurance information and she said they did. I then offered to call the number on the back of her card to verify that indeed she has coverage for her testing supplies. And that's when the journey began... 

I was transferred to about six different people before someone would answer my question. When I did get to the right person, they verified that her private insurance does cover 80% of her testing supplies and Medicare covers the remaining 20%. I was happy that my patient was covered and could start getting the supplies she needed to take care of her diabetes.

But...I was left wondering...if it’s this challenging for me, a health professional, to get answers about coverage, how difficult is it for our patients with very low health literacy to know about their benefits and follow up with their claims?

If you are new to diabetes education or have not worked with diabetes supplies, you may not realize that testing supplies such as blood glucose monitors, test strips, and lancets are a “Durable Medical Equipment” or a “DME” benefit. Sometimes this can get really confusing for our patients since it’s different than a pharmacy benefit. For testing supplies to be covered, the company must be an approved DME provider. For the some plans (like the one I was calling about), they have "preferred brands" of testing supplies that are less expensive for patients.

I write this post to not necessarily complain about the healthcare system, but really to just say it is plain hard for our patients to know their benefits and navigate the healthcare system. This is not the first patient I have encountered that actually had a benefit that a company told them they did not have, and they were paying full price out of pocket.

As diabetes educators, I know we have a lot to cover in a short period of time, but sometimes the biggest challenge that day when we see our patients is paying for testing supplies and medication. I make it a point to ask my patients a little about their testing supplies and medications to see if they need any help in that area.

Here’s more info on medicare coverage for testing supplies and other things.

Here's a patient brochure on medicare benefits. And here's a website about Medicare designed for patients. Check out the new “Blue Button” feature that allows patients to download their personal health information and claims.

What have you found to be helpful in making medicare and private insurance benefits easier to understand for diabetes patients to understand/navigate? Please share your examples and stories!

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