prescription benefits

[chellybeans]

hi all, i have a question regarding my health insurance. i am pregnant with twins and have united health care choice plus. i thought it was great coverage until i found out i have gestational diabetes.

i need insulin and my insurance does not cover it!!!

is there anything i can do to try and get coverage? i am living on a shoestring budget since getting pregnant and having to miss so much work so it's just financially darn near impossible to throw another hundred and twenty dollars a month of expenses in there when i already pay dearly to be insured.

i thought with diabetes being so common insulin would be a drug that would be covered.

any suggestions?

for the record i make too much money for state assistance, just barely , but still.

[chellybeans]

actually i am high risk during my pregnancy and am seeing a maternal fetal medicine doctor as is. insulin is my only option due to the nature of my case, even though i was assured that it most likely would resolve after birth.

i have actually spoken directly to my insurer. our hr is non existent. i work in a 21 person construction company. i also i perused the insurance companies website to seek out alternative treatment options and ways to get my medicine covered. there appear to be none.

i have a full book of what is and is not covered. oddly humulin is not! it amazes me that you could need this for survival and they would not cover it.

i have had this policy for three years, never needed until pregnancy and now find that i may be underinsured. i guess my hopes is to find a way to get the insurance company to revise their insulin policy. it's not like insulin is a pain med, or cosmetic treatment! i am only facing 8 more weeks of pregnancy and feel like if i pursued a consumer watchdog group i would have already given birth before it ever came out.

thanks for your help bob

[InsureBob]

I would first check with your HR department/plan administrator, and get a verification on whether the gestational diabetes, which may go away once the baby is born, could be treated with oral medication, such as Metformin, Glucaphage, etc.

Because most cases of gestational diabetes does go away with birth, they may not want to put you on insulin, which is a maintenance medication.  You may investigate a change in diet, or as stated earlier, oral medication.

Did your OB/GYN specifically state that you needed Insulin?

As for your second paragraph, on the individual market, if you have any form of diabetes, you are not insurable.  If you are in a group plan, the diabetes is covered, and the medication SHOULD be as well.  A call to your state Department of Insurance would be well worth the call.

Diabetes is common, and the reason that it is not covered, in the individual market, is because it can lead to:

Heart Stroke
Neuropathy
TIA's
Amputation
Death
Stroke
Loss of Sight
Prostate Cancer (in males)

Diabetes is an instant claim for the insurance companies, because:

Someone on diabetes needs daily medication
Test Strips and Monitors are also needed daily (very expensive - microchips in the test strips)
Is usually (not in your case, maybe) accompanied with High Blood Pressure

I would ask your HR Person for a copy of the Evidence of Coverage, not just the Certificate of Coverage you received.  This would detail what is and is not covered.

I would then grab a Pre Paid Legal Attorney, contact your local Consumer Watchdog and invite the media.  You'd be amazed how quickly that insulin would get covered.  Insurance companies HATE bad press.