Islets of Hope state diabetes insurance coverage laws

islets of hope home buttonabout type 1 diabetes buttonabout type 2 diabetes buttoncomplications with diabetes buttondiabetes support groups buttondiabetes resourcesbutton for diabetes laws and statutes

Information for this article was compiled and edited by Lahle A. Wolfe, Islets of Hope.

Important Disclaimer

This information for general information purposes only.  

It is not intended to be used a recommendation or endorse- ment of any program or entity

This information is not intended to serve as any form of medical or legal advice.


Article Sources

National Conference of State Legislatures

Government Accountability Office (GAO) report number GAO-05-210 entitled "Managing Diabetes: Health Plan Coverage of Services and Supplies;" released on March 28, 2005.

According to Insulin Pump.net in Florida:

In Florida, you have the right to an external or independent grievance to appeal your health plan's unfavorable decision.  You have the right to file an appeal with any denial.  An external grievance systems allows you to take your dispute with your health plan decision to a doctor or review board unaffiliated with your health plan. Thus, both you and your health plan receive an impartial ruling on its decision to deny coverage of services or treatment.

You can file a complaint against your health insurer with your state's department of insurance.  To receive insurance coverage information or file a complaint, contact the Florida Department of Insurance, State Capitol, Plaza Level Eleven, Tallahassee, Florida 32399-0300 or the Consumer Helpline at 1-800-342-2762.


Federal Laws Pertaining to Persons with Diabetes

Diabetes Assistance Programs

 

Diabetes Laws             

Florida - State Diabetes Insurance Coverage Laws


Hock's offers 30-50% discounted prices on diabetes supplies.  We cannot specifically recommend or endorse any company but we have been listing Hock's in our resource directory for over a year as one of the two cheapest online companies to purchase from.  We recently affiliated with Hock's because our own experience with them has been so positive.  If you do place an order through our site, they will contribute financially towards our cause and you will get reasonable prices for diabetes supplies.

Florida has mandated coverage for diabetes care.

§ 627.6408 - 1995 law - Covers medically appropriate and necessary equipment, supplies and training for the treatment of diabetes.

Summary of Provisions

  • Requirement related to diabetes? Yes
  • Diabetes Education services covered?  Yes
  • Medical nutritional therapy covered?  No
  • Diabetes supplies covered?  Yes
  • Insulin Pumps Covered?  Yes, when your doctor states a pump is medically necessary
  • Specified supplies covered?  No

Per the Florida Senate state website:

627.6408  Diabetes treatment services.

(1)  A health insurance policy or group health insurance policy sold in this state must provide coverage for all medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patient's treating physician or a physician who specializes in the treatment of diabetes certifies that such services are necessary.

(2)  The policy may require that diabetes outpatient self-management training and educational services be provided under the direct supervision of a certified diabetes educator or a board-certified endocrinologist. The policy may further require that nutrition counseling be provided by a licensed dietitian.

(3)  The Agency for Health Care Administration shall adopt standards for diabetes outpatient self-management training and educational services, taking into consideration standards approved by the American Diabetes Association.

History.--s. 3, ch. 95-268; s. 1, ch. 96-279.

From InsulinPump.net:

This legislation does not effect Federal programs such as Medicare and Medicaid.  This legislation also does not apply to individuals who's companies provide health coverage through "self-insured plans".

Medicare recently has begun covering insulin pumps and supplies granted some criteria have been met.  Click here for information

In 1995, the Florida Legislature approved a law that requires insurance coverage for diabetes equipment, supplies and self-management education for most individuals.  In 1996, the law was amended to include managed health plans and HMO's. 

Chapter 96-279.  Section 1.  Section 627.6408 states:  "A health insurance policy or group health insurance policy sold in this state must provide coverage for all medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patient's treating physician or a physician who specializes in the treatment of diabetes certifies that such services are necessary."

Interpretation:  If one of the physicians at NEFEDA recommends and certifies that an insulin pump is medically necessary for you, then your insurance company (if not exclude per above) MUST cover an insulin pump for you.

Contact Us  |  About IOH  |  Our Mission  |  Elizabeth's Story  |  About the Founder  |  Join IOH  |  How To Help  |  Advertise  |  Privacy Statement  |  Site Index  |

Page Updated  08/30/2007