Diabetes Supplies Be Covered?

Thanks for all your cards, letters and phone calls welcoming this new column to help you navigate the murky waters of health insurance from HMOs to Medicare. Sorry, I can’t help the man who was unhappy with his penile implant, but we will print questions, experiences and problems strictly related to insurance coverage.

Here are today’s selections:

Question: My daughter is a type 1 diabetic. Much to her dismay, none of the health coverage policies offered by her company will pay for insulin syringes. They cover the cost of the insulin but not the syringes or the test strips, which are very costly. It seems inane that the method of administering her lifesaving medication should be omitted from coverage.

Answer: Many policies classify the syringes as durable medical equipment, which makes them more expensive for the employer. All you can do now is have your daughter ask her company about improving the policy. Meanwhile, the issue is being considered along with many topics by Gov. Pete Wilson’s Managed Health Care Improvement Task Force, which will report next year. The governor vetoed several health care bills, including one that would have mandated coverage of diabetes supplies, pending the report of the task force.

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Q: I am a federal employee and will be on temporary assignment in another city for three months next year. What happens to my health coverage?

A: When you sign up for a health plan during the open enrollment season, you will get a brochure with details of coverage, including out-of-area rules. Generally speaking, you are protected for all medical emergencies, no matter where you are, according to the federal Office of Personnel Management. But many plans probably won’t pay for routine visits to the doctor when you are away from your home area, says an OPM representative. The Blue Cross and Blue Shield Assn., the largest insurer covering federal workers, does allow participants to use their membership cards anywhere in the country where one of its 62 member plans operates.

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Q: I would like to know why Medicare does not cover yearly mammograms. I think it’s worth exposing and changing, but how?

A: Congress decided in legislation this year to expand Medicare into preventive care on a large scale. Beginning Jan. 1, Medicare will cover annual mammograms. Coverage kicks in immediately, without a beneficiary having to meet the $100 annual deductible. Medicare also will provide coverage for pap smears and pelvic exams every three years for women, and annually for those deemed at high risk by their doctors.

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Q: I had a drug dependency several years ago, but completed rehab and I am healthy now. I even surf. I have several part-time jobs, none of which carry health insurance. How can I get reasonably priced coverage?

A: Shop around. Check the yellow pages for independent insurance agents who represent several companies. Also, call HMOs in your area about individual coverage. Check with organizations that might offer coverage, such as religious groups, alumni groups, and professional organizations where you are a member. If the price still seems too high, call the California Major Risk Program which guarantees coverage regardless of health status. Prices for individual policies range from about $165 a month to $286 a month. The consumer service number is (800) 289-6574.

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Q: My uncle has Alzheimer’s disease. I heard there might be some kind of drug testing program to cover him. Medicare doesn’t pay for drugs.

A: Several experimental drugs are being tested in clinical trials to reduce the symptoms and slow the ravages of this devastating disease. Pharmaceutical companies testing these compounds will supply the drugs and the full costs of the treatment, including all medical examinations and tests, if a person is accepted for the drug trials. You can call the Alzheimer’s Assn. at (800) 272-3900 and ask for the drug fact sheets. But don’t get your hopes up too much. These drug trials are reserved for patients in the early or midstages of the disease.

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Q: My husband will be 61 in January and has HMO insurance through work. He has preexisting medical conditions--coronary bypass surgery eight years ago and diabetes since age 12. Other than being a golf fanatic, he is in decent shape. He plans to retire at 62. What avenues could he pursue for three years before Medicare?

A: Federal law enables your husband to continue his group policy coverage for 18 months after he leaves the company, provided that he pays the full cost of the insurance, both his share and the portion now paid by his employer. That still leaves an 18-month gap until Medicare kicks in. A new federal law, taking effect next year, will require health insurers to make coverage available to individuals who leave corporate employment. However, it is not clear how affordable the policies will be. Each state will decide whether to place pricing limits on the policies.

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Tip of the Month: Got Medicare woes? California has the Health Insurance Counseling and Advocacy Program (HICAP), which helps Medicare beneficiaries with questions, problems and appeals. The statewide program is funded through Area Agencies on Aging and the California Department of Aging. For Los Angeles, the HICAP agency is the Center for Health Care Rights, (800) 824-0780. The Orange County HICAP can be reached at (714) 639-4962. Elsewhere in the state, call (800) 434-0222.

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This column appears every second Monday in Health. Send your questions, worries, tips, successes or failures in living with the health insurance revolution to Benefits Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or e-mail: Bob.R[email protected].