Insurance: What Our Patients Need to Know

Abstract

“Does my insurance cover diabetes education and nutrition visits?” Although employers send benefits packages to their employees and Medicare recipients receive a copy of the Medicare & You 1 handbook, many never read this information. Here's what we need to know to answer our patients' insurance-related questions and what our patients need to know to ask the right questions. The Centers for Medicare and Medicaid Services (CMS) issued a final rule implementing expanded Medicare coverage of outpatient diabetes self-management training (DSMT) services authorized by the Balanced Budget Act of 1997. Effective 1 February 2001, only providers who hold an American Diabetes Association (ADA) Education Recognition Program certificate are eligible to be reimbursed for DSMT. In January 2002, Medicare approved payment for medical nutrition therapy (MNT) for patients with diabetes, gestational diabetes, and renal failure (pre-transplant). Physicians, health care providers, and diabetes educators around the country applauded these added benefits for Medicare recipients. This rule change set a standard for diabetes patients and has led many private insurance companies to include both DSMT and MNT in their benefit packages. It must be noted, however, that there is still much work to be done, in that glucose intolerance and pre-diabetes are not considered a diagnosis of diabetes. Therefore, DSMT and MNT services are out-of-pocket expenses for patients with these conditions. DSMT. CMS covers DSMT and MNT as two individual or separate programs. The CMS ruling also states that one complements the other and that they should be used together in the care of patients with diabetes. DSMT requires a referral from a physician (MD) or other health care provider (HCP), such as a nurse practitioner, physician's assistant, or other approved provider of Medicare services. The DSMT benefit covers over the course of a patient's lifetime one 10-hour initial training within a rolling …