{"id":9526,"date":"2010-08-02T03:54:24","date_gmt":"2010-08-02T07:54:24","guid":{"rendered":"http:\/\/asweetlife.org\/?p=9526"},"modified":"2015-12-27T15:44:26","modified_gmt":"2015-12-27T20:44:26","slug":"health-insurance-companies-are-withholding-life-saving-education","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=9526","title":{"rendered":"Health Insurance Companies Are Withholding Life-Saving Education"},"content":{"rendered":"<p style=\"text-align: justify;\">Education has fallen so low as a health priority that it&#8217;s barely  noticed when the lack of it causes devastating consequences, including  death.  What are health insurance companies thinking when they cover the  cost of life-saving health equipment and deny the cost of learning how  to use it?<\/p>\n<p style=\"text-align: justify;\">My friend, Pamela who has type 1 diabetes, got an <a href=\"http:\/\/www.diabetes.org\/living-with-diabetes\/treatment-and-care\/medication\/insulin\/insulin-pumps.html\" target=\"_hplink\">insulin pump<\/a> and a <a href=\"http:\/\/diabetes.webmd.com\/continuous-glucose-monitoring\" target=\"_blank\">continuous glucose monitor<\/a> several months ago.  Finally, she hoped to be able to better control  her blood sugar. Her health insurance company covered the several  thousand dollar cost of these two devices.<\/p>\n<p style=\"text-align: justify;\">Then they refused to cover the much smaller cost of having someone teach her how to use them.<\/p>\n<p>Pamela has had diabetes for 35 years, since she was 20 years old. She also has <a href=\"http:\/\/www.diabetesselfmanagement.com\/Articles\/Diabetes-Definitions\/hypoglycemia_unawareness\/\" target=\"_blank\">hypoglycemic unawareness<\/a>.  That means she cannot feel when her blood sugar is dangerously low; she  gets no symptoms. A dangerous low can lead Pamela to lose consciousness  and possibly slip into a coma and die.<\/p>\n<p style=\"text-align: justify;\">Pamela has managed her blood sugar all these years by testing it  every few hours and using corrective doses of insulin to bring down a  high blood sugar, and eating to bring up a low blood sugar. It&#8217;s a very  intensive form of management.<\/p>\n<p>If you met Pamela you would have no idea what she has to do every day.  Or that she seldom feels well because of the degree of fluctuation in  her blood sugars.  So while Pamela looks fit, is slim and eats healthy,  she&#8217;s not in good health. And, she has never been able to exercise&#8211;an  important part of diabetes management.<\/p>\n<p>Exercise drops her blood sugar like a stone, both while she&#8217;s  exercising&#8211;and up to 12 hours after. Since Pamela doesn&#8217;t feel when her  blood sugar is low, or any symptoms that her blood sugar is dropping,  exercise puts her at risk.<\/p>\n<p>Even a bit of light walking lowers Pamela&#8217;s blood sugar. Once she ended  up in the ER due to a very low blood sugar in the middle of the night.  To make matters worse, and it&#8217;s something she worries about constantly,  Pamela lives alone; there is no one to help her if she can&#8217;t dial 911.<\/p>\n<p>Frightened to exercise, Pamela has been losing her stamina these last 15  years&#8211;she can&#8217;t really even touch her toes&#8211;and she&#8217;s growing anxious  about her health.<\/p>\n<p>Last fall, she decided she <em>must<\/em> find a way to exercise to  maintain her health and improve her blood sugar control. You should  know, without being able to control her blood sugar and be active she  has a higher risk of diabetes complications&#8211;cardiovascular disease,  blindness, kidney disease, amputation, neuropathy and circulatory,  gastric and nervous system disorders.<\/p>\n<p>Pamela&#8217;s plan was to get an insulin pump and a continuous glucose  monitor (CGM). An insulin pump delivers a steady flow of insulin into  the body; it mimics how a normally functioning body works. Knowing how  to program and use an insulin pump requires rigorous initial training  and education.<\/p>\n<p>A CGM tracks your blood sugar every few minutes so that you can see your  blood sugar in the moment, and see if it&#8217;s going up or down. It has a  warning alarm that sounds when your blood sugar is too high or too low.   Pamela, an educated, committed and responsible patient, decided that  both devices would be the way to protect her from the potentially  devastating result of her hypoglycemic unawareness, finally allow her to  get activity and improve her blood sugar fluctuations.<\/p>\n<p>&#8220;Great idea,&#8221; I confirmed. Yet, this Spring, Pamela showed me how weak  her muscles still are; she tried curling her toes and couldn&#8217;t. Pamela  already had her insulin pump and CGM five months then and still hadn&#8217;t  been exercising. Here&#8217;s why.<\/p>\n<p>To get her pump and CGM Pamela had to first <em>prove<\/em> to her insurance company that she really needed them. So last September she produced a portfolio of documents:<\/p>\n<blockquote style=\"text-align: justify;\">\n<ul>\n<li>A doctor&#8217;s certificate of medical necessity<\/li>\n<li>A 14 day summary of blood sugar results<\/li>\n<li>A graph of glucose trends over an eight week period<\/li>\n<li>A log book of all blood sugar results for an eight week period<\/li>\n<\/ul>\n<\/blockquote>\n<p style=\"text-align: justify;\">\n<p>In total, 15 pages of data showing that her variations in blood sugar warranted the two devices.<\/p>\n<p>Voila! Three months later, Pamela received her equipment.<\/p>\n<p>But Pamela&#8217;s insurance company, having spent $6,559.76 on a continuous  glucose monitor and an insulin pump, and an additional $16,200 this year  alone for the supplies for the two devices, will only pay $250\/year for  her to see a diabetes educator to teach Pamela how to use her  life-saving equipment.<\/p>\n<p>Pamela estimates that she will need about 15 visits with a diabetes  educator.  At most, that will cost her insurance company about $2,000.<\/p>\n<p>To use an insulin pump, ratios need to be calculated for insulin dosing  to match carbohydrates you eat. These ratios need to be calculated  differently for different times of day as blood sugar fluctuates 24\/7.  Once the calculations have been made, there&#8217;s an initial stage of  gathering results, assessment, evaluation, setting programs, making  adjustments and testing the adjustments.<\/p>\n<p>Imagine you&#8217;re a teenager and your father just handed you the key to the  beautiful, new shiny car he just bought you. Yet, you don&#8217;t have a  driver&#8217;s license, you&#8217;ve never had a driving lesson, and he&#8217;s not going  to let you get one. The car cost $32,000. Driving lessons would cost  $300. Sure, you can get in the car and drive. And maybe you won&#8217;t kill  yourself or someone else.<\/p>\n<p>Because Pamela needs the education to use her devices, she&#8217;s been paying  for it out of pocket the past two months while appealing her insurance  company&#8217;s decision that limits her to one and a half visits\/year with an  educator. At the insurance company&#8217;s rate, it will take Pamela 10 years  to learn how to use her life-saving equipment. Ten more years of  difficult to manage blood sugars would almost ensure more diabetes  complications, maybe even death.<\/p>\n<p>Pamela is now up to her eighth visit with her educator and they have hit  a milestone. They now know why her blood sugar hits dramatic lows and  how to avoid it. This means Pamela now walks for exercise without  putting herself in peril like before&#8211;and is improving her health.<\/p>\n<p>A few more visits and Pamela will have the knowledge and the means to  manage her blood sugar for presumably the rest of her life. She&#8217;ll have a  solid edge in preventing further complications and&#8211;save her health  insurance company hundreds of thousands of dollars in retinal and foot  and leg-removing surgeries that won&#8217;t have to be performed, dialysis  time that won&#8217;t have to be booked, a bed in a nursing home that won&#8217;t  need to be reserved and possible prosthetics.<\/p>\n<p style=\"text-align: justify;\">I know this story is one of many. I have another friend who had her  request for a CGM denied. Her insurance company told her that her type 1  diabetes was cured because her A1C was in the range recommended for  diabetics. Not the normal range, just the one meant for diabetics. Maybe  our target audience for increased health literacy needs to include  health insurance company executives too.<\/p>\n<p style=\"text-align: justify;\">All of us pay the premiums insurance companies are drawing from when  they decide to withhold education for preventable health tragedies, and  choose instead to pay the enormous financial bill down the road. Whether  it be for diabetes complications or other conditions&#8217; complications  that can possibly be avoided now.<\/p>\n<p style=\"text-align: justify;\">Many stories in the news lately question whether our dollars are  first going toward insurance executives&#8217; pay and then getting doled out  for our care. Isn&#8217;t it time we insist life-saving education be given the  same priority of dollars as life-saving devices&#8211;and insurance  executives&#8217; bonuses?<\/p>\n<p style=\"text-align: justify;\"><em>Disclaimer: No one has asked me to write this article. I did not  name the insurance company involved because this occurs among many  insurers across the country.<\/em><\/p>\n<p style=\"text-align: justify;\">Originally published on <a href=\"http:\/\/www.huffingtonpost.com\/riva-greenberg\/times-square-bomb-threat_b_562860.html\">Huffington         Post<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&hellip;<\/p>\n","protected":false},"author":25,"featured_media":53098,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1501],"tags":[816],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v22.9 (Yoast SEO v22.9) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Diabetes Education: Why Are Health Insurance Companies Withholding It<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/asweetlife.org\/?p=9526\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Riva Greenberg\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/asweetlife.org\/?p=9526\",\"url\":\"https:\/\/asweetlife.org\/?p=9526\",\"name\":\"Diabetes Education: Why Are Health Insurance Companies Withholding It\",\"isPartOf\":{\"@id\":\"https:\/\/asweetlife.org\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/asweetlife.org\/?p=9526#primaryimage\"},\"image\":{\"@id\":\"https:\/\/asweetlife.org\/?p=9526#primaryimage\"},\"thumbnailUrl\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2021\/01\/ASL-Social-Big-Square-3.jpg\",\"datePublished\":\"2010-08-02T07:54:24+00:00\",\"dateModified\":\"2015-12-27T20:44:26+00:00\",\"author\":{\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/6d40cd415a87ce047f388a30aa8d50e4\"},\"breadcrumb\":{\"@id\":\"https:\/\/asweetlife.org\/?p=9526#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/asweetlife.org\/?p=9526\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/asweetlife.org\/?p=9526#primaryimage\",\"url\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2021\/01\/ASL-Social-Big-Square-3.jpg\",\"contentUrl\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2021\/01\/ASL-Social-Big-Square-3.jpg\",\"width\":1280,\"height\":1280},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/asweetlife.org\/?p=9526#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/asweetlife.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Health Insurance Companies Are Withholding Life-Saving Education\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/asweetlife.org\/#website\",\"url\":\"https:\/\/asweetlife.org\/\",\"name\":\"ASweetLife\",\"description\":\"The Diabetes Magazine\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/asweetlife.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/6d40cd415a87ce047f388a30aa8d50e4\",\"name\":\"Riva Greenberg\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/11ff306bd3be1d6947826b8bf3f71898?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/11ff306bd3be1d6947826b8bf3f71898?s=96&d=mm&r=g\",\"caption\":\"Riva Greenberg\"},\"description\":\"Riva Greenberg is finally doing what she set out to do in high school \u2013 writing her observations of life and human behavior \u2013 little did she know then that diabetes would be her muse. 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