Getting to know commercial health insurance

Figuring out how to utilize your commercial health insurance can be as important as any other task for managing your type 1 diabetes (t1d). When you have a good grasp on understanding your coverage, it can make living with diabetes significantly easier. However, the confusing nature of the system can prevent people from getting the most benefit out of their insurance, so let's demystify this type of coverage.

What is commercial health insurance?

This kind of insurance is coverage that comes from a private entity as opposed to a government program. Most people who have this type of coverage access it through group plans offered by an employer, but it may also be purchased directly from an insurance company or through the insurance marketplace.

Basics of commercial health insurance

When living with t1d, understanding your health insurance and knowing how to get the most out of it are key. Here are a few tips to get you started with confidence:

• Read your Summary of Benefits and Coverage. This is a legally required document for every plan, and it contains a high-level summary of your coverage. It's a great place to start with understanding your financial responsibility and how your plan works.
• Utilize your online insurance portal to answer questions about your plan. If you can't find what you're looking for online, reach out to your member services line to speak to a representative.
• Take into account your deductible and out-of-pocket maximum when structuring your personal budget. If you can plan to allocate funds to help get you from the first day of coverage to the point when your plan starts paying, it will alleviate some of the financial stress associated with the beginning of the plan year. You might also consider scheduling any large planned healthcare expenditures — like purchasing a new insulin pump — during the time of the year when you expect to have met your out-of-pocket maximum, setting yourself up for 100% coverage when possible.

Durable medical equipment coverage

When your doctor prescribes supplies for your diabetes care that is obtained through your durable medical equipment (DME) coverage, that prescription needs to land at a DME provider that is contracted with your insurance plan. This can change from year to year, so be sure to confirm the information before starting the process.

As a DME supplier, Edgepark contracts with many of the major commercial health insurance companies including Anthem BCBS, Humana, UnitedHealthcare (UHC), and Cigna. Your out-of-pocket costs will vary based on your individual plan coverage, so it's important to be familiar with your plan details.

When you're going through the ordering process, it's your responsibility to confirm that the prescription is billed accurately. Be an active participant throughout the process by communicating with your insurance and DME supplier as necessary. This can help you avoid tricky situations — for example, it's better to notice that something has gone awry early on than to realize when your delivery hasn't arrived on time.

Coverage variation

Just like your individual health needs for managing your diabetes may be different from someone else's, your insurance plan can vary significantly as well. Even if you and a friend both have coverage from the same company, your plans may still be different. If you have any questions about coverage or want to be able to verify that you were billed correctly, reach out to your insurer's member services line for answers or confirmation.

Do you have more questions about accessing your diabetes supplies through your insurance? You can learn the ropes here.