What this in essence means is that the patient would not be able to choose his own brands of medication; he must only buy what the committee has recommended, otherwise, he would lose out on his health insurance payments.
A woman who faced a problem similar to that mentioned above talks about her experience as a diabetic. She said that when the health insurance company stated that they would be able to pay for a higher priced drug to control diabetes, than the one that the committee recommended, she argued and fought it out with the company, until, eventually, they agreed, albeit reluctantly, to pay for the higher priced drug 'Glucophage.' Her experience was that as soon as she started on hits drug, she found to her amazement that her sugar levels had started to drop considerably, and that her vision, which had been deteriorating for quite some time, gradually started to return to normal. Her problems were not over, however. (Damocles; Bykin, 2004)
According to this woman, when her employers became aware of the fact that she had experienced a loss of vision because of her diabetes, they started to consider her more of a liability than an asset, especially in relation to the steep costs that the company would have to incur in term of health insurance payments and other benefits for her. She was fired, and she found herself with no job, and also no health insurance, and with a chronic disease to manage. Since she had already exhausted all her savings in trying to pay for her medications, and really could not afford to pay for her insurance premiums any more, she found that she was in a tight quandary indeed. There were no jobs available for an over-qualified fifty-five-year-old, and by the time she found a small job, she was off her all important medication for almost a year, because of which she lost her vision, and developed serious cataracts. (Damocles; Bykin, 2004)
In America today, there are almost eight percent children and adults, who live without life and health insurance, and it is a fact that the uninsured population will continue to grow steadily over the next few years, unless some sort of action is taken by the government and by health insurance companies. (Iom, 2004) It must be remembered that health care in the United States is considered to be one of the most expensive in the entire world today, and in general, access to health care is dictated and controlled by private and government based insurance companies. As far as the diabetic population is concerned, about 10% to12% is left uncovered by health insurance. (Ekoe; Zimmet; Williams, 2001)
For a diabetic, as mentioned earlier, the costs of managing the disease, seeking health care, and insurance can be prohibitive indeed, and a diabetic, on an average, spends about $13,243, when compared to a healthy person, who spends about $2,560. This is the reason why accessing health insurance is extremely important for an individual with diabetes; costs must not deter the person from seeking out the best medical care available to him. (Yu; Stjernholm; Munier, 2004) This is especially true where minorities, such as Hispanics and ethnic races are concerned. (United States Congress; Select Committee on Aging, 1992) The U.S. Health Care system is in general oriented towards the reactive treatment of disease, and as a direct result, the costs of providing health care is largely motivated by illness related care. (Clark; Cefalu, 2000)
Health insurance companies must gear up to deal better with diabetics, and in certain states, like for example in Montana state law allows health insurance companies to turn people who approach them for insurance, at will, based on the status of their health, and in most cases, diabetics are considered to be 'uninsurable'. (Montana: American Diabetes Association) Obtaining insurance cover can therefore be an uphill task for a diabetic, and some agencies, like for example, the Diabetes Federation of Ireland in conjunction with ERM Financial Services have managed to negotiate, with insurance underwriters, a number of schemes that a diabetic would find useful in managing his disease efficiently, as also in availing of health insurance benefits. Some of these are: Motor Insurance, Travel Insurance, Group specified Illness and life cover, Group Personal Accident Cover Mortgage & Mortgage Protection Facility and Household Insurance Cover. (Diabetes & Insurance: Diabetes Federation of Ireland)
Research has revealed the fact that among adults who have diabetes, almost 92.0% have some form of health insurance or the other, but at the same time, almost 640,000 people with diabetes do not have any health or life insurance. Of those diabetics wit insurance, 10.3% are covered under Medicare, 69.3% by private health insurance companies, 5.5% by military benefits, and about 14.1% through Medicaid. Among these people, there is absolutely no difference in the types of diabetes; the health insurance is accessed by insulin-dependent diabetes mellitus sufferers, and also by non-insulin dependent diabetes mellitus sufferers. However, there are subtle differences between coverage for males and females; everywhere, it was found that males availed of more health insurance than females. (Harris, 1995)
When the sufferer is a child, then the problems become compounded, because of the fact that diabetes places severe restrictions upon one's lifestyle and habits. One case is that of a woman, whose son, aged 19, is a diabetic. He is covered by health insurance, under the mother's, and also under the father's plans, which are sponsored by their employers in the state of Oregon. The son would start to receive insurance from SSI and from Medicaid, both through the state of Washington. Suffering from severe depression and anxiety and other related symptoms, he has reached a point where he does not care any more about managing his disease. His parents and his doctors are at the present engaged in trying to get him admitted to the Cumberland Hospital for Children, where people up to the age of 22 are admitted, but the fact is that the insurance company will not accept this, and is fighting the parents all the way, and the parents have had to employ an attorney at great cost to manage these issues. (Children with diabetes, insurance costs, ask the diabetes team)
Another similar case is that of a young girl, who has to purchase test strips that would test her urine ketones. Expensive to buy on a regular basis, her parents sought help from the insurance company that handles her case, but the company refused outright to cover the test strips, even though it is a very important part of her management strategy for diabetes. (Ask the diabetes Team)
To conclude, it must be stated that the quality of health insurance that is available to diabetics in the country today is more often than not inadequate, and a diabetic must be ready and willing to manage his disease with the little or no resources available to him. The government and private insurance companies must sit down and formulate policies that would handle the issue in a better manner, so that these chronic sufferers would get some respite from the great burden that the disease places on their resources.
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Children with diabetes, insurance costs, ask the diabetes team" (January, 2006)
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