Type 1 diabetes

Insurer exclusions mean access to insulin pumps just got harder

News that a major health insurer will exclude insulin pumps from its policies is a blow to patients, according to Diabetes Australia.

WA’s largest health insurer HBF has announced the new exclusion will apply to basic hospital cover from July 1, along with exclusions for obesity surgery, cochlear implants and dialysis.

With insulin pumps costing between $8000-$10,000, the move has raised concerns for Diabetes Australia, which says people holding basic policies will have to upgrade or switch funds to retain cover for insulin pumps, while others may not even realise they have lost it.

“For a lot of people it’s the main reason they take out health insurance, so they know when they need a new pump or are ready to start on insulin pump therapy they have someone to cover that cost,” says DA spokeswoman Renza Scibilia.

Currently about 15% of patients with type 1 diabetes patients use the device, she estimates.

According to Ms Scibilia, some basic hospital policies still cover insulin pumps, but insurers are amending policies all the time and details of any changes can be hidden in the fine print of the updates they are required to send out.

Clinicians can play a key role in helping their patients be aware of this potential pitfall, she suggests.

“When you’re having the conversation about [whether] it’s time for a pump upgrade or thinking about pump therapy, it’s ‘do you have the right level of cover?’

“We’re not asking doctors to have a list of insurers to recommend, but just to make sure that people realise the field is not even and the goal posts are shifting.

“Unfortunately this is another part of all of those tasks to make sure we are staying on top of our diabetes, to make sure we are getting what we want out of our health insurance,” she adds.

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