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Are there benefits to having a pediatric endocrinologist? My insurance company has refused to allow my 8 year old son (Type 1) see one. We are certainly not satisfied with the endocrinologist we have now.


Yes, there are substantial benefits to having a pediatric diabetes team take care of kids with diabetes! We've recently answered a similar question about the reasons why.

The Managed-Care insurance companies are trying to take over the decision-making in the field of medicine. But there are still options for patients and their families, if indeed your child is receiving inappropriate care:

  1. First, speak to your son's Primary Care Physician about why you're unhappy with your son's present care; ask him/her to write a letter of support for your request for a referral to a pediatric endocrinologist.

  2. Second, call your employer's Employee Benefits department, and discuss whether there are other insurance options you can use that are less restrictive (but probably more expensive).

  3. You can call the insurance company's Customer Service Department, and ask to speak to the Ombudsman or Case Manager, and explain your problems to them. Sometimes they can cut through the red-tape, and arrange a referral (but they will probably have to show a justification to their company's Medical Director, and maybe to a Medical Review committee, before they can do anything helpful, however).

  4. If these ideas doesn't work, write to the Medical Director of the insurance company, and explain your concerns; send a copy of your letter to your state's Insurance Commissioner. Send the Medical Director's letter by Certified Mail, with a Return Receipt request.

  5. If there's no answer from the Medical Director, write to your state's Insurance Commissioner, with a copy to your Congresspeople. Send along copies of all your previous correspondence!

  6. If any of your son's physicians refuse to listen to a valid complaint, file a complaint with the physician's State Licensing Board.

  7. If there's an urgency that can't wait for all these steps, take your son to see a pediatric diabetes team out-of-network (which means out-of-pocket expense) and keep all the receipts. Send the receipts to your insurance plan, and ask for reimbursement. Plan to take the Insurance Company to small-claims court someday to reclaim your money if your arguments are strong enough.

Remember, it's the squeaky wheel that gets the grease, and it's your son's health that's at risk. And that's infinitely more important that a few more dollars in the Insurance Company's bottom-line profits!


Original posting 12 Dec 97


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Last Updated: Tuesday April 06, 2010 15:08:56
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