Insurance Coverage?
Hello :)
I'm still pretty new here, so bear with me if this is something that's been gone over a million times.
My BF is T1 and I want to know how we can get the best care/coverage for him. We're on a fairly low income, but it's just high enough to squeak us out of getting those lovely tax cheques :(. Our health coverage hasn't been great in the past, but the job I'm at now has a pretty good plan. Just from browsing websites and forums lately I've seen that a lot of people say that you need to call the insurance company and directly ask them what they will/won't cover, and that yoiu may be able to challenge that under the right circumstances?
I was wondering what everyone here does and how I would go about finding out about better coverage for his insulins and supplies. He's begun thinking about getting a pump lately, so I'm wondering what the chances are that some of that cost will be covered.
I was also wondering if there's anyone in the Edmonton area, or if anyone knows of some sort of support group? I haven't had any luck finding out, but TBH I'm not sure I could get him to go even if there was one, lol.
Anyways, thanks in advance!
Becky
Tags: Edmonton, T1, coverage, insurance, pump
Replies to This Discussion
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Permalink Reply by Loke on -
The insurance thing is entirely dependent upon the insurance company and the contract your company has with them.
For example, my last company had a great plan where they covered the premiums and everything under the sun was covered for 80% of the cost with no questions asked. My latest company only covers part of the premiums and I have to fight with the insurance every few months.
You should have a person at your company who manages the health insurance contract and they should be able to find out for you if certain items are covered or not. If not they should be able to give you a number to call to find out. You will need the DIN (dispensing identification number) of the item you need to know about as a general name is too vague. For example, you ask if Insulin is covered and they say yes. However, for example, you require natural Insulin and then find out they don't cover it.
I had to fight and get a list of items covered which takes higher management. This was because the first line person would just read from the pamphlet that only meters were covered, which I would then confuse them since I get most meters free.
If an item is not covered then you will need to go to whoever manages the contract and get the item covered in the contract, which may raise your premiums. I raised a stink about pumps and someone else in the company needed coverage for pumps so they added pumps to the contract for the next year (after saying premiums would be too high).
You can rarely challenge them on coverage as your contract will spell out what is covered or not.
Hope this helps.
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Permalink Reply by nel on
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Hi Librarychick.....hope this is helpful : information on insulin coverage in the province of Alberta ,relatively recent announcements .What I can't locate on the CDA website is typical coverage of meds, insulin needles etc. ....maybe CDA is updating/has deleted ?? I wonder if you can get an answer by calling the CDA telephone number given in the articles ??
http://www.diabetes.ca/get-involved/community-news-entry/alberta-go...http://www.diabetes.ca/get-involved/community-news-entry/canadian-d...
Another important recent update about drivers licence http://www.diabetes.ca/get-involved/news/alberta-transportation-ann...
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