Doctors should determine what’s medically necessary – not insurance companies

8.31.17

In yet another example of health insurance providers impeding patients’ access to medical care, Anthem Insurance has decided to deny coverage of what is being hailed by some as an “artificial pancreas device” designed for automated delivery of insulin for many patients with diabetes.

Why? The major insurer has decided that the closed hybrid loop insulin pump and sensor system – approved by the FDA in 2016 – is “investigative” and “not medically necessary” for all diabetes patients for whom it is prescribed.

According to an article in Diabetes Daily, Anthem is the only major insurance carrier that is refusing to cover the system, a Medtronic product.

The Diabetes Patient Advocacy Coalition (DPAC) further outlined that, while Anthem has indicated it might provide the coverage patients paid for if they have Type 1 diabetes and meet certain requirements, it does not feel that the system is necessary for patients with Type 2 diabetes.

“For individuals with Type 2 diabetes who are prescribed insulin or insulin pump therapy for diabetes management, this policy guideline is disconcerting, as the Type 2 diabetes community grows each day and more individuals are being prescribed insulin,” DPAC stated.

This is disturbing news indeed. Insurers should not be making medical decisions for patients – doctors should.
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