Health Insurance, Social Networks & Behavioral Change
Hello. Let me be as authentic as possible and say that I work for a very large health insurance company, and that what brings me to join this site is that I believe health insurance companies should be encouraging their members who are touched by diabetes to join social networks.
I have two questions for anybody who wishes to respond:
1. Do social networks bring about positive behavioral change?
2. Is there a role for insurance companies in this conversation, or is this level of mis-trust so high that they should just stay out?
Many of us may have been burned by insurance companies in the past, and I should say up front that I don't have the knowledge or power to influence anybody's specific insurance issue -- even (sad to say) if it was with my own company. It's an amazingly complex system. I will say that I used to be in higher education, but I left to join a health insurance company because it is the number one issue affecting our country. I believe the power of networks and communities haven't yet been brought to bear on the issue. Your thoughts?
I have two questions for anybody who wishes to respond:
1. Do social networks bring about positive behavioral change?
2. Is there a role for insurance companies in this conversation, or is this level of mis-trust so high that they should just stay out?
Many of us may have been burned by insurance companies in the past, and I should say up front that I don't have the knowledge or power to influence anybody's specific insurance issue -- even (sad to say) if it was with my own company. It's an amazingly complex system. I will say that I used to be in higher education, but I left to join a health insurance company because it is the number one issue affecting our country. I believe the power of networks and communities haven't yet been brought to bear on the issue. Your thoughts?
Replies to This Discussion
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Permalink Reply by Toni Crebbin on
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The answer to #1 is absolutely! I believe the key to being healthy should be a holistic approach; mind, body and spirit. Even though I am a T1 with no complications, and have a very supportive family, I have always felt a bit alone when it came to the disease and other people understanding my periodic frustrations. When finding tudiabetes, it felt great to have a place where others understood me, and I never felt judged. The tips I have learned here to help finetune my care is more than a doctor has ever given me. Don't get me wrong, I have one of the best endocrinologists in the nation, but he can only tell me so much and I can only absorb so much in one visit. For the in-between visit issues that come up, or the issues I can research on this site, on my own time, is priceless.
As for insurance companies themselves being here, the only reason I would want them here is so that they could here that they need to change their ways and start being proactive. It is very frustrating for people like me to know that if I took poor care of myself, then the insurance would basically pay 100% for my care. But because of the proactive approach I choose to take, then I have to pay for all of my continuous glucose monitor and supplies myself. I have never cost my insurance anything more than prescriptions, regular labs, and doctor visits. You would think they would want me to continue this good care...something is wrong with this picture!
Sorry if I vented, but you asked:)
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Permalink Reply by JDavid on -
I agree wiht your reply in many aspects, maybe all.
I am labeled a T2, but don't quite fit either T1 or T2 pigeon hole... the ins cos and even the VA frustrates/d me (That is why I decided to go doctorless for a few eyars, feeling I could do better on my & just bought my insulins OTC, till I got into trouble last year) . I now have a highly reguared edo I see at the local diabetes center,; my wife also sees this same doc at his private practice, the level of care is almost like night and day. Another subject.
My ins co expects me to test 4+ times a day, but I have to pay out of pocket to afford it. They only cover select meter/strips and the deductable is way higher than buying my preferred meter and strips over the counter.......
Complications -v- "good care"............In today's market I think they just hope you will be with some OTHER ins co when complications arise, and get by as cheap as possable, till the buck passes.
SUPPORT groups... would be nice to have a LOCAL human network. NOBODY, not even a doctor IMO that is not diabetic can begin to understand much beyond the numbers. I had a consult last year with a nurse that was a T1 diabetic herself and she UNDERSTOOD what I said w/o having to TRY and explain.Simple it takes one to know one wheather its diabetes cancer (been there) or anything else.
I learned more from a webMD forum, which is where I learned about Tu...than from all my docotrs over 25+ years.. So much of my diabetic life and has been a hit or miss and even contention (at times) with my doctors. Being a diabetic can be a very lonely place where few if any realy understand
Dealing with diabetes can be depressing enough w/o problems or lack of understanding with insurance cos and even sometimes doctors.
BOTTOM LINE......I say YES!
(*&*( GOMER
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Permalink Reply by elaine peterson on -
That must be it exactly....the insurance companies assume we will be with another company when the complications strike. It seems obvious, though, that someone else with another company now will be with them when their potential complications present themselves. Short term bandaids vs longterm fixes.
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Permalink Reply by Jody Chesen on -
Toni: I TOTALLY agree with all you've said here. (and with most of what everyone else said too).
1. Sites like this one are INVALUABLE to a Diabetic (especially those "in between" in age where you are now officially a TYPE 1 (not a JUVENILE) Diabetic. The knowlege that is shared is GREAT. You can have the most well intentioned friends and family supporting you but when your BS hits 250 or 48 (sometimes in the same day, sometimes one right after the other) they just can't relate.
2. Regarding the insurance companies. They have it BACKWARDS, a perfect example: My husband and I applied for Life Insurance (not even Health Insurance since we both are covered by his job, thank G-d) and aside from the fact that he is three years older (and a non-diabetic), there really is no difference between us.....HE got covered, BUT they would not cover me (pre-existing condition) at least not cheaply like him.....When you are healthy no problem....When you are "sick" they won't cover you.....BUT without coverage how can we stay "healthy" (ie being able to afford what we need to do so).
Brian: Sorry for venting but thank you for at least TRYING to understand. I for one appreciate it as I'm sure we all do. Thanks.
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Permalink Reply by Manny Hernandez on -
Hi Brian,
Thank you for being open about your work affiliation and thanks for joining our community.
I very much believe in the power of social networks and the positive impact they have on affecting patient behavior. I have gotten innumerable messages from members who have expressed how they have been able to improve their diabetes management and learn more about how to better do things related to it since they joined diabetes. Besides that, the fact that members join the community puts them in touch with others who are going through the same things they are going through: this has a VERY powerful emotional impact, because they realize the are not alone. As obvious as that may sound (because of the millions of people with diabetes), it is a reality that most people with diabetes simply go at it alone... and that can make the challenges more challenging and the successes (such as an improved A1C) not as rewarding (when you have good news, you normally want to share them!)
As for health insurance companies (in the US at least), for a long time they have not (in general) been connected to a very important reality:
While they are a business and they have stockholders to respond to, the business they chose to be in is one of facilitating things for patients to BE HEALTHY.
In my humble view, I think that profits have clouded that mission, resulting in millions of non-insured people that are left to fend by themselves when it comes to taking care of their health expenses.
The health insurance company that considers insuring individuals with diabetes is a company that will get millions in business! The premise is simple:
-If the patients can afford to access to the healthcare they need (including supplies, diabetes education and devices to help with diabetes management, such as Continuous Glucose Monitoring systems), they WILL take better care of themselves. And healthier patients are an excellent thing for insurance companies... as long as they are covered by them.
So what I am thinking is this can be a win-win situation:
* Patients who are currently not "insurable" can win by finally getting access to the healthcare they need and WANT.
* Health insurance companies can benefit by insuring patients that, through access to the healthcare they need, generate business for the company.
I am sure it is more complex than what I am describing it as... but I cannot tell you how complex can things get with diabetes when you are not insured.
I hope these thoughts and those of the rest of the members (I am going to make sure to pass this along to our membership, to get you as much feedback as possible) help you convey to your organization about our needs and hopes as patients.
Take care,
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Permalink Reply by petes2cents on -
Q1 > I do believe a strong social network, online and off are extremely important.
Q2 > I do not trust insurance companies, at all. The level of greed is too high, And this comes from personal life experience, in addition to inside information from doctors, in my family, that are part of the system.
We need serious change in our health care system...
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Permalink Reply by Carolyn Deans on -
Q1: Social networking sites have been very valuable to me for two main reasons: (1) Diabetes is very complex and I often want to talk to someone and get opinions on various things more frequently than I can meet with my doctor. I also want to get a variety of different opinions. Additionally, many of the devices and supplies needed for diabetes are very expensive, so knowledge from someone with experience with the various devices is valuable when deciding between various options.
Q2: A potential role for health insurance companies on social networking sites might be to observe and see what issues people are having so that they could then brainstorm about how to provide solutions for their patients. Another potential role for health insurance companies in social networking might be to have a representative offer suggestions for how to get the necessary supplies for a low cost, although this may be difficult since coverage is complex and different for everyone and companies may not want the liability of having someone online making statements about coverage that may not apply to everyone.
Hope this is helpful. Good luck with your research.
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Permalink Reply by Michael on
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For what it worth:
From my perspective the answers are yes and yes. Social Networking: As a member I have learned invaluable lesson from the experience and wisdom of the social network. Decisions on extended or combination boluses provide a starting point; I didn’t have to start at square one. We are all individuals and our reaction to insulin varies but it is much better than going in blind. The value as expected is from the collective wisdom – people with years of experience helped me from making the same mistakes, being aware of the common and not so common issues we face. I wouldn’t do something just because everyone else does – but I would look into it as a possibility. Insurance Companies: This also applies to the insurance companies who can access real-world experiences. They can see how their decisions really affect the community – are they spending money on thins that diabetics don’t use or care about. Or are they on the same path we are on – more of a shared experience and less of this is how we do it experience. The insurance companies may already do this but it would be encouraging to see them getting involved.
Great to see you involved Brian and asking the question. Welcome.
Michael
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Permalink Reply by Dave Shikiar on -
Brian,
Social Networks when used authentically, are very beneficial. My son has type 1, (he's 12 now) and I have learned so much about all the different treatments, pumps, continuous glucose monitors, from TuDiabetes. In fact, reading Toni's post, I just learned about a new pump that she uses, the animas ping...Also learning of the difficulties with insurance companies through this sight has made me very aware, and empathetic for those who's situation is mis-understood by insurance companies. Perhaps insurance companies should look to employ some people who have conditions like diabetes, to be part of the decision process, so they can make more informed decisions from those who have it..
We are very fortunate that our insurer, through the Simi Valley Unified School District has been very good for my son. He's on a pump and we just got approval for continuous BC monitor with the help of his doctor and Medtronic.
Pro-active care that promotes good health has to be considered as a + when determining other expenses related to diabetes. If you are here to get opinions and try and make a difference at the health insurance company you are working at, well good luck and I hope you can make a difference for others..
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Permalink Reply by elaine peterson on
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The networking support, practical and emotional, that we receive from each other here is invaluable.
I have great insurance, but I worry that it could end anytime. While the insurance companies need to focus on more long term preventative coverage, I'm not sure that the problem doesn't lie as much with the pharma and healthcare industries. They are all businesses whose goals are to profit from, not cure my disease.
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Permalink Reply by Michael TOTA on -
i I READ YOUR COMMENT, BUT I DIDN'T UNDERSTAND WHAT YOU WANT TO SAY! CAN YOU BE MORE SPACIFIC?
THANK YOU AND HAVE GREAT HOLLYDAYS!
MOLFETTESE
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Permalink Reply by MelissaBL on -
1. I have always been a very positive, motivated person and a very frustrated, nihilistic diabetic. I have spent many a doctor visit feeling defensive about my efforts and discouraged about results. Stumbling upon this social network has allowed me to consider specific problem/solution scenarios that are too specific for my once-a-quarter interaction with a talented endocrinologist. Endos have hundreds, if not thousands, of patients and they tend to consider the broader aspects of care - such as overall neurological, eye, vascular, and other complication-sensitive health. The minute details of daily care and daily struggle are often brushed aside as too individual and daunting to visit in detail. We go to certified diabetes educators and medical device trainers hoping for more specifics, and we get some (if insurance will cover it!), but we often learn the rules of care and not the exceptions that will inevitably pop up. To sum up, what I get from TuDiabetes and other social networks that I don't get from medical staff is SUPPORT, LIFE EXPERIENCE, TECHNOLOGY (innovations and news), and SPECIFICS for my care. I have brought my A1c down almost a percentage point since implementing ideas from my community.
2. The level of mis-trust is high. I agree with Toni that it seems that compliant diabetics are often punished by not gaining access to coverage for the tools that keep them compliant. I had a plan that didn't allow quarterly educator visits. A plan that wouldn't cover the quantity of strips I needed to test enough to stay in range. Etc., etc. CGMS is another poignant battle on our front lines right now. I've always said you have to be the sickest of the closely monitored diabetics to get attention from insurance. I enrolled in a program long ago with my insurance where a nurse is supposed to call me regularly because I'm a type 1. I have yet to receive a phone call. I'm sure it just looks good on their books that I joined the program, so I did. But some nurse in a cubicle at a healthcare company doesn't make me feel warm and fuzzy about compliance and control of my condition. A site like this with names and faces and anecdotal evidence does. So insurance could encourage it, but I don't know how they could go about making particular endorsements about communities or monitoring your active involvement.
For one thing, if I thought my insurance company rep that decides my CGMS coverage was a member on this site, I'd shut up pretty quickly about anything and everything I need support from my community for. There's certainly a fear that they could use information about the details of my care against me.
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