Disease Management - A Coporate Affair


#1

I just had to enroll in a disease management program called Matria. The company I work for now requires anyone with Asthma, Diabetes, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, or Coronary Artery Disease to participate in this program in order for them to subsidize your insurance through the company. I’m pretty miffed about it! The program requires that I keep in touch with them (answer their annoying calls) and give them personal medical info to prove that I am taking “good care” of myself. They offer their own advice without consulting with any of your doctors, and keep reports on you. They say it is to help cut back on insurance costs from complications, and is a tool to help those in need, but I’m not so sure. From those I’ve talked to In human resources, it seems to be a scare tactic.

Let’s say you have diabetes and you need gallbladder surgery. You’ve tried to keep your A1c down, but it is 9+ before the operation. After the operation, and you develop complications because of high sugars. The insurance company will then pay for your surgery, but not the extra costs from complications, because you failed your personal responsibility of maintaining your health. Matria has the records to prove it…

That is the theory. In real life I think any lawyer would jump on a case like that, because even those who take the best care, can’t always manage their condition to “acceptable levels.” Regardless, this invasion is disturbing, and I wonder if anyone else has come across programs like these in the workplace.


#2

WOW! I am very sorry to hear about this. Are you the one who is providing the information to them or is your endocrinologist? I would be tempted to just “miss” their calls, or even just block them. The Dr cant’ release your information without your concent, so that might be a way to keep Matria in the dark.


#3

If you miss the calls, then the insurance company can withhold payment for meds, endocrinologist visits, everything else. It’s a catch-22.


#4

My opinion? the way things are going the insurance companies will use it to say that you arent taking care of yourself and wont pay! To me; this world is nothing but "greed."
It is scary. Privacy is being invaded upon more and more. sigh… and here I am getting ready to give up my privacy for a diagnoses of diabetes and more control? What am I doing? Is my health going to be at the mercy of an insurance company? (or how much money we make per month?) I’m still questioning my choices. Your post just really sets me to thinking harder.
MeadowLark


#5

I know it sounds scary, Meadowlark, but you’ve got to muster up some courage and go to the doctor anyway. Your blood sugars are not normal and if you keep them high like they are, you may (or more to the point you will) run into complications down the road. Whether it’s losing your eyesight and not being able to see any grandbabies or it’s losing a leg and not being able to play w/ any grandbabies or it’s having a heart attack and not living to see any grandbabies, you don’t want it. I thought it sounded like you were close to actually seeing a doc so I’m hoping to help prevent a slip backwards. Get your husband to get everything worked out so you can go see a doctor. They will also most likely find you a certified diabetic educator who can teach you how to eat to keep your blood sugars down. From your last menu descriptions, you might be ingesting way too many carbs without knowing it. Go see a doctor as soon as you can.


#6

It is a total Catch-22! Apparently our company is “self-insured” meaning that the insurance company negotiates down the price and our company pays the lowered bill. Also our company isn’t supposed to know any medical details (such as the condition). They only get notified that we were compliant or non-compliant. They way they know whether you have to participate in the program, are through the codes filed for prescriptions related to that particular diagnosis. Our company is also requiring everyone to enroll in a Quality Health Screening, or get your own doctor to send them a report on a yearly physical. Seems so intrusive…I think I’ll go to that with a cigarette in one hand and Ben & Jerrys in the other!


#7

I agree with Kimberly. I certainly didn’t want to stop you from getting the medical attention YOU NEED. Please see the doctor, and take care of yourself!


#8

Thankyou for your friendship and concern… Nope you have not stopped me from slowly filtering all this out. These are questions that I have always had.
Almost 25 years ago when I was working in an office; this very kind of thing was starting to happen. Because I was healthy; it didnt bother me.
Now, alot of things will affect us as a family. I will be going to a dr thru military insurance for only the period of time that Stephen( husband) is activated. That means insurance will stop as soon as he is deactivated. Then, with no insurance,medicine etc… and not great paying job to deal with all the extra. I’m just trying to weigh it all. I still kinda think that now I would like to see a doc. Even though it is scary.
I just need to keep processing all the stuff/emotions etc…
It is gonna take a bit of time for the “TriCare” to kick in so that I can go. ( if )
MeadowLark


#9

Hi Chloe-

This is part of a major trend in the health care world. Even though your employer’s plan is self-funded, they are still subject to the HIPAA nondiscrimination rules, which prohibit wellness plans from imposing penalties larger than 20% of the cost of coverage. (Here is a link to a summary of the recent rules. http://www.groom.com/documents/WellnessFinalRules-GLGSummary.pdf
People with Diabetes need be actively involved in crafting these regulations otherwise we will end up being punished for our genetic code and receiving poorer coverage than those without chronic conditions.


#10

Are you sure that the disease management company has any communication with your insurance company beyond whether you participate or not? My insurance has an optional wellness-program that sounds just like this. Weekly phone calls and coordination of information between doctors. But there were all kinds of disclaimers that the information would never be used by the insurance company.


#11

The insurance company is the one reporting to the company that I have to participate. They share my medical history with them, and that’s how they flag us down. I’m not sure if Matria reports back, but I think the way the girl in HR explained it to me, they might if there is a problem that makes the bill higher. Ours is optional too, if you want to pay more than double the subsidized premiums. The money thing kind of makes the decision for you.


#12

This really scares me too! In fact, I wrote a post about in on my blog a few months ago…http://progresstrumpsperfection.blogspot.com/2007/02/wellness-program-or-intrusion.html

I’ve just seen the inefficiency and ineptitude of insurance companies and would hate for us to be at their mercy in judging whether we are taking proper care of ourselves.


#13

this is exactly what I fear… also because of the fact that I would be a “dependant” under my husband’s sponsorship since it is military insurance. ( TriCare) ugh.
I dont want my husband penalized for my inabilities to do something.
OR if I were to eat a treat and have a higher number …say during holidays,b-days etc.
I’ve got to keep questioning. I’ve got to find out what will happen to my husband’s career due to my health… besides the fact that we will only have this “insurance” for 8 months. Is it worth it to start something I cannot finish?
MeadowLark