The only advantage an insurance company has for diabetics as a group would be the difference between the discounts they can negotiate with healthcare providers and the amount we would be paying as premiums. Any advantages we currently get by being part of employment-based groups (which include both high- and low-risk members) would be obviated by that system. The cost of consumables, if subsidized, would more than eat up the difference between the retail cost of medical services and the insurer-negotiated rate. If you’re concerned about your out-of-pocket costs right now, expect them to skyrocket once you end up in a diabetes-only group.
It is hard to say for sure what the answers of these questions are. Lets start with question number 1. I do beleive that social networks make a difference. However, they make a difference where they find a proper framework. I beleive that this site is important, precisely because it grew up independently of and free from outside interference. In short it is genuine. What might an insurance run site be? Could it be independent? Could it provide freedom of expression? I doubt it.
On the second issue. One could certainly perceive the development of the site as a violation of FMLA, if it is operated by an insurance company and at arms length by the employers who largely pay for the services. My take is that if a site were run by an insurance company the material disclosed could and would inevitably end up as a cause for an FMLA violation. The company would know the sign on’s, the employer pays the insurance company and wham someone will put two and three together and claim they were fired for medical information disclosed on a site like this. Even if they voluntarily disclosed it. I have thought about this for several years as I operated several employer health plans. I just don’t see it working. Lets say an insurer gives financial support to such a site and in exchange promotes it? Same thing. Even if the stie not controlled by the insurance company it presents a terrible FMLA issue.
No this needs to stay away from Heath Insurers, it is at its best a private venture.
Now if you wish to waste health insurance money run of those things that is a health information and preventative care service. Those things do not work for chronic illness, they do work for new diagnosis, but if person has had a chronic disease for more than 10 years, it is a bother. Give it up. I say that after paying for it time and again. I also wanted to these things work, but it is a complete waste of money for those with ten of more years with a chronic disease. i wish it did, it just does not. Spend the wellness dollars elsewhere.
Rick
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Do social networks bring about positive behavioral change?
Yes information is knowledge and knowledge brings confidence. -
Is there a role for insurance companies in this conversation, or is this level of mis-trust so high that they should just stay out? Yes, The more the Insurance companies understand about this disease the better for everyone. I believe the reason the
Insurance companies deny certain services is from the lack of knowledge. No they should not stay out. The most recent treatment CGM, Is still being denied by most insurance companies as experimental.The studies have shown that people using Cgm have much tighter control and lower a1c’s than people not using this.With better control we have fewer medical problems which saves the insurance company money.
Personally…it has been a positive relationship that I have with my company. But I pay a high premium to have that relationship.
I would encourage interaction. I do not mistrust my company.
Staci
Thank you James for pointing out this link.So what is exactly the difference between these five countries and the system in USA? What is the preferable changes all like to see on health system to suggest to the new administration?
Sohair, the program takes an hour or more to watch, so there is a lot of information to summarize.
All countries in the special are capitalist democracies - Japan, UK, Germany, Taiwan, Switzerland - like the U.S. But all five offer either some kind of national healthcare program or at least access for all individuals in their low-cost private care system. There is no such thing as being bankrupted by health costs in these nations!
Japan’s residents are very healthy and love going to the doctor and go often, but hospitals are suffering under major financial stress. All of Japan’s medical procedures have a set fee that is standardized by the government.
The UK’s national healthcare system is a completely socialized system.
Taiwan reorganized their healthcare system later, taking with it all of the best from the different systems around the world.
I really recommend watching the videos online. I learned a great deal.
I have not been on tudiabetes for very long but I definitely feel that communicating with others who are in the same situation "diabetes or any other medical condition is very helpful I commend those who started this web site For just knowing that their others out there who have or are goiing through this has helped me to feel stronger It is not just insurance companies the medical profession seems to also have limitations I firmly believe that knowlege brings power I have gotten alot of experience fightin for my autisitc sons rights I have always told myself the more knowlegdge I have going in has made me alot more stonger.Right now my one complaint is how expensive the strips are and how tsting 4 times a day uses up what the insurance companiy alooughts a lot quicker than a months worth. I read in these letters I am not the only one with this situation Thank you for being there
Yes, it’s the thought of insurance companies reading our community to “track” people that is indeed scary. Or even making being part of a site like this “mandatory” or something for clients.
Yes, I like this. The original poster could post as an individual but be asked to disclose his affiliation at the top of each post. Please do this.
Rick…you just reminded me of something…your quote first …
" One could certainly perceive the development of the site as a violation of FMLA, if it is operated by an insurance company and at arms length by the employers who largely pay for the services."
I had cancer surgery back in '82 and worked for and covered by Met Life, great coverage…BUT when my employer learned of the Dx…EVERYTHING changed. We were at a meeting in Columbia SC and the regional home office mgr came over and personally told me how sorry he was to hear about my cancer…(as if a 10% chance of surviving 12 months and only 2 years into diabetes were not enough)…Then when we got back to North Charleston (SC) my office mgr told me I was no longer welcome at Met Life…talk about the "IF"s in life. He tried talking me into staying in the busines, I was good at it and offered to set me up with Prudential etc…They starved me out of business, the week the auditors were there I took home about $1,400 on a 10 week draw, the next week it was $87 and change… We lost our home and became homeless with 3 young childre, one in diapers yet. IT was ALL ILLEGAL, but no help fighting was available…
We moved to Orlando Fl where there was more work in my field, computers.I looked for work while living out of 2 older cars and went to the local health dept for my morning insulin. I found work in DP at Florida Hospital and got back on our feet. I found an interist (diabetes) and oncologist for C-fiollow-up. We ahd a change of bosses a few months later. One morning I went in early for my Xrays for my oncology apt durring my lunch break. There was no place to put the big Xrays except on my desk. A day or two later I was called in by 2 of my bosses. They had looked up (ILLEGAL) on their computer and found out I was going to the oncologist across the street…yep I was put on notice my presence was no longer welcome. About another week later they made up some story for an excuse to fire me… I never missed a single minute of work, the bosses BOTH missed work due to STDs from their off work relationship though).can you say double standard?
Given the oppertunity employers AND insurance companies will one way or another, circumvent the law and moral obligations and us little people are powerless!
(&( GOMER Voice of X-perience
Many of you do not know that most insurance plans in the US are not really insurance. That term is a misnomer for most people in the US. In fact, almost all employers greater than 50 people are self insured. Here is the way it works. The employer sets aside x number of dollars in a health insurance account. The administrator called a TPA (third Party administrator) evaluates the claims and decides which ones fall into the acceptable category for payment. The TPA is paid a slight amount for this service.
Once the claims have been adjudicated by the TPA, the funds for the weekly payment go to the TPA’s account for disbursal. The TPA looks like an insurance account but they are not they simply pay what the employers plan states. Backing up this process are usually two or three other organizations. The first and most important is the reinsurance provider. The reinsurance provider in essence insures the employer or plan sponsor from catastrophic loss. Let’s so for instance take an employer of 50 who had three cancers or a preme and two heart issues. It could wipe out a complete plan in one year. So the employer takes reinsurance to protect against high claims. The second is the network. The network is a group that negotiates for better pricing from providers. Let’s take a look at the doctor. You go see the doctor and the rate is $100.00. Well that is the street rate. However, almost all doctors are part of a network and as such the network is paid a fee to reprice their services for the plan. Typically, for a doctor you might see 70% of the actual charge. The plan sponsor in effect saves money because they do not have to pay the full amount of the street price for the service.
So lets put this in context. Why does a plan sponsor enter into these arrangements? Well first, it saves money. An insurance company has to charge a rate based on last years claims plus profit, plus medical inflation plus reserve. A plan sponsor does not have to account for profit. Therefore, their charge is for last years claims, reserve and medical inflation. The plan sponsor also does not have to pool its reserve. Therefore, if the plan has a poor year the employees of that plan group pay the price. In pooling if, the group poll has a bad year all members have to pay for it. That better allows for the use of wellness plans etc.
So what does all this mean? Well first, for most people the insurance company is your employer. If you have an individual plan then this doe snot usually apply to you. That makes comparison shopping for most people really a fallacy. Second, if you do not like the terms of the plan, chances are it is the employer you should address. Chances are they not the TPA is ultimately responsible of the plan design.
Rick
Welcome Brian.
First off, I wouldn’t be here if I didn’t need a social network. I am kind of a recluse and get out very little (by choice, not necessity), so this gives me great advice from people that know best, great support from friends all over the world, and a feeling of belonging I have trouble finding. So yeah, I think a social network is pretty awesome.
As for the insurance stuff, I think most people will understand it is your job and are not in a position to change things. I work in a box office and cannot control what we show or how much to charge, so that applies to lots of jobs. I have pretty good insurance, but still pay alot out of pocket since insulin has never been genetic and the insurance company won’t pay more then a month at a time and I use more then that. Sucks to be sick. Their ceo’s should have to deal with it, then we will see change.
I hope you learn a lot while here. These are great people.
Q1 - Absolutely I believe they bring positive change. People are encouraged especially when they have found a place to hang their hat and connect with other people dealing with the very same issues as they are. Regardless of diabetes or any other disease, social networking works.
Q2 - I love this network because of how non sterile it is. Insurance companies are employed with people who have diabetes too and experience the same issues as the people here. No company or workforce is immune to diabetes, cancer, heart disease… We never know but that person following company policy on the phone or making decisions could very well have T1, T2 or family members or loved ones with it.
If change is to be made, knowledge and accesability to it is key. So I encourage engagement with insurance companies but would like it on a personal level…not one of barriers.
Brian,
Thank you for joining & for opening this discussion.
Yes, I firmly believe that social networks facilitate positive behavioral change regarding any issue. Regarding diabetes, I think this is particularly effective. As a condition requiring self-care, sharing knowledge, personal experience is critical. Goes without saying that the emotional support & encouragement is just as important. For many, diabetes is isolating. My heart has ached reading posts from members about the lack of understanding (& often outright insensitivity) from family, friends, doctors, teachers. Throw in misinformation intentionallly disseminated by the ADA & it becomes a maze to navigate alone.
We never get a day off from being diabetic.
Tu Diabetes has been the single most important factor in helping me manage. I’ve gained more here than from health care professionals. I learn something new constantly. Knowledge is power, right? From our youngest members to the oldest, everyone has something valuable to contribute. Thanks to the vision & hard work of Manny & Adreina, this a safe space.
I wish I could say that insurance company participation would be a positive addition to our community. Wouldn’t it lovely to think that this would encourage greater understanding. But as you suspect, the trust isn’t there. Personally, I don’t see how it could be when insurance is a business & the prime directive is making/saving money.
What I’m curious about is what insurance companies would hope to learn. Do they really not know that customers are upset by being dictated to regarding our lives? Do they not realize that it’s absurd that we have to fight to test our BG as much as needed? Are they oblivious to the fact that we often can’t get the meds we need? Surely, the irony that those who have good control are penalized is already an established fact. How many times do they need to hear that CGMs are a vital part of saving lives? Yes, I question the true motivation behind insurance companies lurking here.
The sad part of this is that it is strictly a business designed to make a profit. They don’t care about us, we are not people to them, just numbers. Nobody in their right mind would willing become a diabetic and everyone of us would leave it behind if given the chance. But we do have it, we are stuck with it for life and they are making money off of it as a result. I pay a lot for my meds and that is with a co-pay. But then they dictate which drugs I should be on based on their estimate. We have never spoken, they don’t know me. Why are they allowed to make those choices. Ok, done ranting, breath, breath.
The answer to # 1 is a very definite yes. In fact, I would say a special center for diabetics would be profitable for many of us. This kind of thing would not be for just anyone, but for people with special problems. It would be a fully functional operation and not for excessive profit. The center’s function would be to assist all diabetics in their diet, exercise, medication and social encouragement (along with spiritual health). It would take into consideration the total person and not just diabetes. Many diabetics have other health problems as well. The center could have regular professional people who do nothing else but take on the cases of diabetes in people. Each individual is different and have different needs. What better place could a diabetic go to get answers to their questions as well as their frustrations?
The answer to #2 was answered by your own statement: “it’s an amazingly complex system” The insurance company use that complexity to confuse people and, I dare say, deceive people for their own gain. I don’t trust them either.
Everyone needs to have socialization with any health condition, the support of family, friends and strangers that soon are friends are the only way anyone can learn more and deal with the situation at hand.
We don’t all sit in a big office or have alot of money due to the cost of the economy. With the cost of medications going up and alot of medications that don’t really work the point of wasting our money for insurance or co-pays is what? they do need to come and read to know what people are dealing with with any serious illness, The depression from the day they find out they have a condition without a cure to the day they are not able to pay for medication due to the cost. Do they really care that the medication did or did not help people? Do they look in to the claim after it is filled to followup and see if the patient had to go in for a different medication cause the first one did not work, do they know why it did not work.
On another note, Why do they let the doctors and hospice get by with saying a person died from self starvation? When a person can not do for themselves due to the complications and the nurses refuse to assist with feeding or the doctor won’t allow a feeding tube (in a nursing facility, the person is in for short term care) then a month later they die. Is this the type of care they want to pay for so they don’t have to pay for the cheaper end for preventitive supplies? Paying for preventitive care to maintain better health keeps the monthly premiums arriving at their door, dead people don’t pay premiums of any kind.
Thanks for listening and sorry for sounding upset, this disease can do that at times with issues.
- Do social networks bring about positive behavioral change?
If the social networks are addressing specific issues and the people involved are committed to providing good information, rather than the all too often occurring tirades of abuse and barrow pushing that can happen on internet forums, then social networks can bring about very positive behavioral change. In relation to social networks for specific problems that can often be difficult for those suffering those problems the gains from social networks can be substantial. For example, recent research suggests that even strangers can lift our mood. Being positive, being supportive, not always pushing your favourite barrow, not regarding others as potential protagonists but as individuals you care about and wish to help, can make for a very positive network that can help all involved.
- Is there a role for insurance companies in this conversation, or is this level of mis-trust so high that they should just stay out?
What if a social network run by an insurance company providing health insurance established a pattern of service provision that demonstrated a “one size fits all” approach to the decision making of the insurance company? It could be very revealing but I suspect that the insurance company would have more to lose by providing such a social network as it would bring together people who collectively might uncover deficiencies in the provision of services.
Perhaps better for all concerned is a social network where people covered by different companies could compare and contrast their coverage. That would be much more informative and beneficial to those in the social network.
I do think social networks change our behavior for the better. I would like to see more of it in my work but fear stops people from reaching out to one another. They also bring a sense of conscience and responsiblity to our society, which makes us a better people. The friends that I have found on this site are invaluable,this kind of thinking should be incorrperated into insurance companines
I think that there is a role for insurance companies if they would listen to the needs of the people and try to help in times of need, even lowing their prices so as to keep their clients, which I know they wont do. I feel that disabilites should be rated accourding to their serverity, and their insurance should reflect that. We also need to have these companies give us a break on our supplies, expand their coverage to include what we need, neddles,meds Dr visits, and more. We are people too!
In this time of ressesion it is hard to stay consistent with our meds if we have to pay for them all of the time. I try to stay as healthy as I can, but there are times when my Sugar gets high, it is then I would like to know that I could go to the Hospita if I needed to and be covered.
Special Center for Diabetics…I go to one, that is where I see my endo.
I find it a mixed bag. They have some great people there docs, nurses, dietician, CDE and such and a few not so great. It’s also sort of a dumping ground for diabetics that other docs do not want to deal with their diabetes management. When my primary sent me there on consult it was better, I saw the dietician once, a nurse trained my wife (I was going in for surgery and my wife avoided learning to do shots for 25yrs) and I had one left-over consult and I made great use of it. I saw a nurse that was a type-1 herself and had almost a full hour, very helpfull. BUT, later I was sent there as a regular patient and rationig took over…no more such visits available…
I like the idea but what I would like to see is more like a NON_PROFIT co-op resource type of operation Owned by diabetics, run by diabetics, FOR diabetics.
(&( GOMER