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Indiana State Department of Health

Chronic Disease > Diabetes Prevention & Control Program > Health Insurance Indiana Insurance

   

Indiana Legislation of Diabetes Insurance Coverage

What is covered?

Medically necessary treatment for diabetes, including medically necessary supplies and equipment.  For example, blood glucose monitors, blood glucose test strips, insulin, syringes, insulin pumps and accessories and oral diabetes medications.

Diabetes self-management training, which includes:

  • One or more visit(s) after receiving an initial diagnosis of diabetes.
  • One or more visit(s) if it is determined by a physician or podiatrist that there has been a change in your condition or that a change in treatment is medically necessary.  For example, you have been able to manage your diabetes with meal planning and now must begin oral medication or insulin.
  • One or more visit(s) for re-education or refresher training ordered by a physician or podiatrist.

Who is covered?

  • Anyone with diabetes (insulin or non-insulin using) and elevated blood sugar as a result of pregnancy or other medical conditions.
  • Must be covered by insurance, Medicaid or the state health plan to qualify.
  • If unsure of coverage, contact your employer's human resource department to verify coverage.

When does coverage take effect?

  • Coverage for IC 27-8-14.5 takes effect when your insurance policy is renewed. 1998 Legislation.

How am I reimbursed?

  • Written order from a physician or podiatrist for medically necessary supplies, equipment and/or self-management training.
  • Self-management training must be provided by a licensed health care professional who has special training in diabetes management.

What to do if my claim is denied?

  • Verify you have appropriate documentation to get reimbursed (i.e., physician order).
  • Ensure your health plan is not self-funded (which would not be covered under this bill).
  • Resubmit your claim with a letter of explanation regarding your condition (keep a copy for records).
  • If you receive a second denial, call the Indiana Department of Insurance Consumer Assistance to file a complaint at 1.800.622.4461.

Does this apply to Medicare coverage?

No, not under Indiana legislation.  However, beginning July 1, 1998, Medicare will reimburse the cost of blood glucose monitoring, blood glucose test strips, and diabetes self-management training for any person with diabetes (insulin or non-insulin using).

The Mission of the American Diabetes Association is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.  For further information on IC 27-8-14.5, national legislation, or information on the legislative progress, contact the ADA at 1.800.DIABETES (1.800.342.2383).

Additional Information: