Insurance Coverage of Diabetes-Related Goods and Services in New York State

[Gina Capone]

From the Dept. of Health website in NY

Insurance Coverage of Diabetes-Related Goods and Services in New York State
Private Health Insurance Plans

In January 1994 the diabetes insurance law became effective. The provisions of chapter 378 of the laws of 1993 and chapter 338 of the laws of 2003 can be found in Insurance Law §§ 3216 (i)(15-a), 3221(k)(7) and 4303(u). The law states that medically necessary diabetes self-management education and education relating to diet* will be covered when it is provided by:

* A physician or other licensed health care provider legally authorized to prescribe treatment.
* Staff as part of an office visit for diabetes diagnosis or treatment
* Certified diabetes nurse educator
* Registered Dietitian
* Certified Nutritionist or Dietitian

*Coverage for self-management education and education relating to diet shall also include home visits when medically necessary

This law also requires insurance coverage for various diabetes equipment and related supplies. The list of equipment and related supplies which may be medically necessary for the treatment of diabetes includes but is not limited to the following items (regulatory authority: 10 NYCRR § 60-3.1):

* Lancets and automatic lancing devices
* Glucose test strips
* Alcohol swabs, skin prep wipes and IV prep (for cleaning skin)
* Blood glucose monitors (e.g. glucometers)
* Blood glucose monitors for the visually impaired
* Continuous glucose monitoring systems
* Control solutions used in blood glucose monitors
* Diabetes data management systems for management of blood glucose
* Urine testing products for glucose and ketones
* Insulin and inhaled insulin
* Insulin infusion devices
* Oral and injectable anti-diabetic agents used to reduce blood sugar levels
* Injection aids (e.g. insulin drawing-up devices for the visually impaired)
* Cartridges for the visually impaired
* Disposable injectable insulin cartridges and pen cartridges
* Other disposable injectable medication cartridges and pen needles used for diabetes therapies
* Oral agents for treating hypoglycemia (e.g. glucose tablets and gels)
* Glucagon emergency kits
* Syringes
* Insulin pumps, equipment and supplies for use of the pump (e.g. batteries, semi- permeable transparent dressings; insertion devices; insulin infusion sets; reservoirs; cartridges; clips; skin adhesive and skin adhesive remover; tools specific to prescribed pump)

Insurance coverage is:

* Not based on the type of diabetes or whether or not the patient uses insulin
* Subject to same deductibles/co-payments as required for similar types of benefits in the insurance policy or contract

This law applies to:

* All Health Maintenance Organizations (HMOs)
* Health insurance policies, which provide comprehensive or major medical coverage
* Health insurance policies, which cover outpatient services, performed in a physician's office

This law does not apply to:

* Medicaid Recipients
* Union-sponsored benefit plans that are self-insured
* Medicare or Medigap (Medicare supplemental policies) beneficiaries
* Plans which insure employees in more than one state
* Employer-sponsored benefit plans that are self-insured
* Health insurance policies which were not issued in New York State

[Hank L]

Medicare is my primary and Empire Blue Gross Blue Shield PPO is my secondary thru my former job. Dexcom filed with them on 7/31 so I'll let you know when I hear something.

I know Medicare does not cover CGM but Dexcom tells me they filed with them but I can't seem to get any info from Medicare,

[Gina Capone]

I heard Medicare and Medicaid is NOT covering CGM

Hank L said:

Medicare is my primary and Empire Blue Gross Blue Shield PPO is my secondary thru my former job. Dexcom filed with them on 7/31 so I'll let you know when I hear something.

I know Medicare does not cover CGM but Dexcom tells me they filed with them but I can't seem to get any info from Medicare,

[Hank L]

I received a check today for all of my supplies to date.

[nina Jeffers]

Luckily my insurance company Aetna NY covers the Continuous Glucose Monitoring. I am of the opinion that it is very important to have a good insurance. Nowadays it seems to be that you can get an insurance for nearly everything but the important question is what do the actually really cover in case of an unpredictable mishap. Recently I concluded a new home insurance. Hope that it is a good one.