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“The Human Side of Diabetes – Health Insurance & Medicare”

Jul 2, 2004

Not a week goes by where I don’t get calls from patients, friends and colleagues about how to deal with Health Insurance companies and Medicare about some aspect of their diabetes care. I have decided, in an effort to reach many more people to share the advice here that I have been giving my patients for the last few years

You need to be proactive. You need to establish a relationship with your Insurance company and managed care person before you need help or have a problem. I promise you that it will save you a great deal of time, frustration and aggravation.
Find a day when you are calm and collected and not rushed and harried. I suggest you avoid Mondays and Fridays as those are the craziest days to contact any Insurance company. So get some coffee, a pad and pencil and be prepared to spend a couple of hours on the phone. Make sure you have prepared your part. Do you have your policy numbers, group plan numbers, social security number and the date you became enrolled in the plan? Have it in front of you before you make the call.


Then ask yourself some questions. What do you want from the company? What do you need now and what will you want them to do for you in the future? Are you submitting a claim for care that you have had or need to have now or are you looking for information to prepare for the day you need something?

Calling a company when they have denied a claim or you feel they have made a mistake is a completely different situation than establishing a plan of care or a relationship for the future.

I suggest you contact the company at this time and ask to speak to your Managed Care person or case worker, or what ever title the company gives them. Remember at this point you are going to be patient and not upset or angry when you get transferred from person to person for a while. I know you hate to deal with recorded instructions but that is the way the world works now. It will not help to scream at the machine. Listen to all the instructions and do ask they ask.

Be persistent and take the time to explain who you are looking for. You want to actually talk to the person, if possible who will be following your claims and approving or disapproving the expenditures in the future.

When you get to the proper person remember this person will be an important part of you diabetes care management. Introduce yourself and tell them why you are calling. Explain that you know diabetes care can be expensive and that you will be making every effort to care for yourself and keep your self well and out of hospitals.

You have become educated about your diabetes and will be making regular visits to your health care provider, testing your blood and keeping as good glucose control as possible. You then talk about your expectations from them. You expect them to pay for your regular healthcare, education and covered supplies, (and exactly what do they cover) and to partner in your diabetes maintenance. After all, this plan is intended to help save them money in the long run. (Since we can now prove that tight control of glucose will help them avoid complications that are very expensive.)

You then explain that you will call a couple of times of year to tell them how you are doing.

Does this sound like a fantasy to you. I have known many of my patients to follow through with this and been quite successful. It is far more reasonable that calling the companies from an emergency room or during a bad episode in the doctors office when you are ill. It works better than when you are furious after a claim has been denied and try to explain things to a person who does not really know the rules and regulations have changed in your state since legislation was passed last year. I often give patients copies of the state legislation and requirements so they can send copies to the person in billing who denied or might deny their claim.

I have met wonderful people in the Insurance and Managed care sector who are grateful to establish contact with patients at this level. I have even conducted seminars for companies that asked me to educate their caseworkers on how to deal with people with diabetes more effectively.
If you are a person with diabetes this advice may save you a difficult experience in the future and give you and opportunity to take more control of your own health care.

If you are a health care provider this might give you some insight as to what kind of information your patient really needs to survive the health care arena.

Try it. It just might save you a lot of time, energy and aggravation.

Take care.

Ginger Kanzer Lewis has been teaching people with Diabetes for almost thirty years. She is a Registered Nurse with a Masters Degree in Education from Harvard University and Certification in both Diabetes and Continuing Education and Staff Development. Ginger has spent over twenty years teaching educational methodology to health care professionals while working as Director of Staff Development or Education in Hospitals through out the North East. Ginger is the immediate Past President of AADE and is a well known national and international speaker.