How much does my insurance cover?

[SteveDE]

A question we hear frequently is will my insurance cover this diabetes education? We understand how Medicare and Medicaid works, the problem is there are so many various private insurance plans available, what do you do when presented with this question?

Our current response is the patient is responsible for knowing this and they are the ones that need to call the insurance company and determine how their insurance will cover it. I believe this is generally inefficient and is lacking in customer service. I certainly understand it is the patient's responsibility, however, if we can have this information upfront, provide it to them, they will be able to know they can or can't afford it or maybe a payment plan or work on financial assistance forms upfront. Any help in your process or procedure when it comes to answering this question would be appreciated!

[SHGR, MSN, RN, CNS]

...as we should all know diabetes is a very expensive disease in terms of finances and those finances cause my patients increased stress, that increased stress causes lack of compliance and increased glucose. My responsibility is to help them learn a healthier lifestyle and often times that healthier lifestyle deals with cost.

Yes, I wasn't politically active before, and now I find myself actually researching the costs and coverage, and writing letters to my elected officials encouraging pre-diabetes coverage. I do believe that we DE's save all stakeholders a bundle (including society as people feel better, live longer, more productive when DM is well-controlled).

[classicdame, MSN, EdD]

be careful. If you quote a price the patient will hold you to that, and you could be wrong. I have people tell me "I have Blue Cross. Will they pay". Blue Cross and all other insurance companies have multiple contracts. How could I possible know what their contract stipulates?

That said, pre-autorization with the insurance company will probably help, but the patient should make the call.

[Sam J.]

Also, is the nurse in the hospital required to know how much each bag of IV fluid and the cost of each pill for each patient and every insurance? No? My point exactly. It is not possible to know what every patient's insurance does and does not covered and the costs. That's just ridiculous. I took offense to that, because costs are NOT my responsibility, patient care is.

I think, really, most people that work in healthcare have a pretty good idea about what things, or drugs, or procedures cost- and everyone in healthcare has a hand in controlling costs, on some level, if no other way that reducing or preventing waste, that we all pay for. As far as knowing the price hospitals charge- even hospitals can't answer that specific question. A bag of saline that might cost $2- one patient may be billed maybe $5 (maybe to Medicaid), while a private pay patient may be billed $250. But again, I was referring to generalities. As noted above there are plenty of web sites that list common prices for almost everything imaginable- if you don't feel healthcare workers ought to know these costs, at least you might want to know for yourself in the event you are ever faced with decisions about your own healthcare, and what you are being charged. It might be an eye opener?