Location:
DISEASES; INSURANCE - HEALTH - MANDATES;

OLR Research Report


February 26, 2010

 

2010-R-0121

DIABETIC NEUROPATHY AND INSURANCE COVERAGE

By: John Kasprak, Senior Attorney

You asked if any states require health insurers to cover diabetic neuropathy pain treatment.

SUMMARY

No state appears to specifically require coverage for diabetic neuropathy treatment. But a great majority of the states require health insurance policy coverage for diabetic treatment. Most require coverage for both direct treatment and for diabetic equipment and supplies for use by patients at home. In some situations, this may, in effect, provide some coverage for treatment related to diabetic neuropathy.

BACKGROUND

Diabetic Neuropathy

Diabetic neuropathy is a peripheral nerve disorder caused by diabetes or poor blood sugar control. The most common types of diabetic neuropathy result in problems with sensation in the feet. It can develop slowly after many years of diabetes or may occur early in the disease. The symptoms are numbness, pain, or tingling in the feet or lower legs. The pain can be intense and require treatment to relieve the discomfort. The loss of sensation in the feet may also increase the possibility that foot injuries will go unnoticed and develop into ulcers or lesions that become infected.

In some cases, diabetic neuropathy can be associated with difficulty walking and some weakness in the foot muscles. There are other types of diabetic-related neuropathies that affect specific parts of the body. For example, diabetic amyotrophy causes pain, weakness and wasting of the thigh muscles, or cranial nerve infarcts that may result in double vision, a drooping eyelid, or dizziness. Diabetes can also affect the autonomic nerves that control blood pressure, the digestive tract, bladder function, and sexual organs. Problems with the autonomic nerves may cause lightheadedness, indigestion, diarrhea or constipation, difficulty with bladder control, and impotence (see National Institute of Neurological Disorders and Stroke (NINDS; http://www.ninds.nih.gov/disorders/diabetic/diabetic.htm)).

Treatment and Prognosis

According to the NINDS, the goal of treating diabetic neuropathy is to prevent further tissue damage and relieve discomfort. The first step is to bring blood sugar levels under control by diet and medication. Another important part of treatment involves taking special care of the feet by wearing proper fitting shoes and routinely checking the feet for cuts and infections. Analgesics, low doses of antidepressants, and some anticonvulsant medications may be prescribed for relief of pain, burning, or tingling. Some individuals find that walking regularly, taking warm baths, or using elastic stockings may help relieve leg pain.

The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. Treating diabetes may halt progression and improve symptoms of the neuropathy, but recovery is slow. The painful sensations of diabetic neuropathy may become severe enough to cause depression in some patients.

Research

The NINDS conducts and supports research on diabetic neuropathy to increase understanding of the disorder and find ways to prevent and cure it. New medications are examined to assess improvement or stabilization of neuropathic symptoms.

STATE COVERAGE REQUIREMENTS

As best as we can determine, no state specifically requires health insurers to cover diabetic neuropathy treatment. But as of mid -2009, 46 states and the District of Columbia have laws that require health insurance policy coverage for diabetes treatment generally, according to the National Conference of State Legislatures (NCSL). (The four states without such a mandate are Alabama, Idaho, North Dakota, and Ohio.) Laws in Mississippi, Missouri, and Washington require only that insurers offer coverage, but not necessarily include the coverage in all active policies. Most states require coverage for both direct treatment and for diabetes equipment and supplies that are often used by the patient at home.

For diabetics, coverage of prescription medications, including insulin, medical supplies such as insulin syringes, and equipment such as blood glucose monitors, is important. Under the Texas Insurance Code, equipment includes blood glucose monitors, including noninvasive glucose monitors and glucose monitors designed to be used by the blind; insulin pumps and associated equipment; insulin infusion devices; and podiatric appliances to prevent complications associated with diabetes. Supplies include test strips for blood glucose monitors; visual reading and urine test strips; lancets and lancet devices; insulin and insulin analogs; injection aids; syringes; prescriptive and nonprescriptive oral agents to control blood sugar levels; and glucagon emergency kits (Texas Insurance Code Secs. 1358.001 et seq.).

Massachusetts requires coverage, under equipment and supplies, of therapeutic or molded shoes and shoe inserts for people with severe diabetic foot disease (see http://www.mass.gov/legis/laws/mgl/32a-17g.htm.) Arkansas has a similar requirement (Ark. Stats. Secs. 23-79-601 et seq.). California requires podiatric devices to prevent or treat diabetes-related complications (Calif. Insur. Law Sec. 10176.6) as does Nebraska (Neb. Stats. Sec. 44-790). New Mexico law specifies medically-necessary podiatric appliances for prevention of feet complications associated with diabetes, including therapeutic molded or depth-inlay shoes, functional orthodics, custom molded inserts, replacement inserts, preventive devices, and shoe modifications for prevention and treatment (NM Stats. Sec. 59A-22-41).

Kentucky requires coverage of all medications necessary to treat diabetes, if prescribed by a legally authorized health care provider (KY Stats. Sec. 304.17A-148). Michigan requires coverage of medications used to treat foot ailments, infections and other medical conditions of the foot, ankle or nails associated with diabetes, if prescribed by an allopathic, osteopathic, or podiatric physician (Mich. Stat. Sec. 500.3406p).

In most state legislatures, however the two terms (“supplies” and “equipment”) are used interchangeably and may not be defined.  Some states have issued regulatory guidelines further defining the terms.

For more information on individual states' requirements see the full NCSL Report at

http://www.ncsl.org/IssuesResearch/health/DiabetesHealthCoverageStateLaws andPrograms/tabid/14504/default.aspx?TabId=14504.

JK:sd