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Old 01-28-2007, 01:31 AM
labob labob is offline
Member
I am a: Type 2
 
Join Date: Feb 2006
Location: Los Angeles, California
Posts: 292
If you are a member of an HMO, your doctor may be being paid on a "capitated" ("per head") basis, which is especially common on the West Coast. That means that your doctor's office gets a set payment for you every month, whether you see the doctor or not. The kicker is that whether you need no care, a little care, or a lot of care, you doctor's office gets paid the same amount. That's why many doctors who participate in HMO plans push preventive medicine -- it's in the doctors' interest to keep you healthy because the office will still get the monthly payment for you, even if you don't need any medical care.

My understanding of the industry is that in the past, there were incentives to keep the total amount of prescriptions down. I don't think that's the case any longer -- if you need strips/drugs, your doctor should prescribe them. My guess is that if there are limits on the number of strips you get per month, it's doctor that is limiting the numbers, not your insurer. When I was first diagnosed, my doctor prescribed 8 strips per day, which my insurer paid. Now that things are more under control, the prescription calls for fewer strips per day (right now it's 4 per day). But that's a decision between you and your doctor.

When I was getting settled in, though, I did test more often than now. It's worth testing a lot at the beginning -- even if you have to pay for a pile of strips yourself. The number of times that you test per day will probably go down once you get things under control, unless you are taking insulin (in which case, even if you're under control, you need to test a lot).
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