The American Diabetes Association recommends that people with type I (insulin-dependent) diabetes test blood glucose levels at last four times a day. My doctor would like me to test before each meal, before bed, and before and after exercise. But my new insurance policy just slipped in a limit of 100 test strips a month. Wisconsin state law says insurance companies must cover diabetic supplies. The company says they're within the law because they are covering supplies, but the policy my employer bought only covers about three tests a day. The company also said a letter of medical necessity is worthless as this is the policy I chose from my employer. Do I have any recourse, like accusing them of offering a policy with substandard care for diabetics? Studies have shown that more frequent testing cuts down complications in the long run.

T.H.

Insurance coverage for diabetes self-management, treatment and supplies is a very popular mandated benefit these days, not to mention necessary for those who suffer from diabetes. Like other mandates, diabetes coverage can be expensive. Most of the laws governing this benefit contain language similar to the following: "Requires all policies and plans that cover hospital, medical or surgical expenses to provide coverage for specified equipment and supplies for the management and treatment of diabetes."

Your insurance evidently pays for a significant portion of the cost of diabetes testing and management. Rather than seeing the limit of something your insurance company "slipped in," perhaps it is more helpful to see that your policy pays for more than three test strips per day! Considering the cost of test strips, that saves you $50-$75 per month. The fact that your insurance limits the number of test strips covered by the plan does not limit the number that you can purchase yourself. Believe it or not, some people think that if their insurance doesn't pay for it, they can't have it!

It is true that Wisconsin state law requires coverage for diabetes supplies, but the law does not specify the type and number of the various supplies. In this and every other coverage issue, the insurance company must comply with state and federal laws and the regulations that implement the laws. The insurance company must file its coverage plans with the states for approval before offering them to the general public. So, undoubtedly, the Wisconsin Department of Insurance read your insurance contract carefully to determine whether it complied with state law and approved it.

Does your policy truly offer substandard care for diabetes? True, it may not pay for every single item that you need, but then that is not the purpose of insurance, and your insurance pays for most of your diabetes testing needs. Obviously, the Insurance Department is satisfied that your coverage complies with state law.

As always, I urge you to consider the cost of paying for the items not covered by your policy, especially low-cost items. If your insurance pays for 100 test strips and you need 120 or more in a month, what is the net cost to you? Your share is only one-sixth of the cost of the test strips. How much is that? At 50 cents per strip, 20 would cost you $10. At 75 cents, it would cost you $15. If you purchase the strips in larger quantities to supplement the number paid for by your insurance plan, the cost may even be as low as 35 cents each.

Test strips are available at discount drug stores and on the Internet at a reasonable cost. Several general medical websites have links to a selection of online pharmacies, where you can shop for the best price. Bargain shopping sites provide alerts to promotions and coupon deals at various online retailers, including drugstores. You may even consult some of the websites aimed at those with diabetes. Shop around, and you might be surprised.

Do you think insurance is too expensive? Most people do. One of the reasons for this is that insurance is required to cover more and more services every year, and even many low-cost items and services. Just think how expensive car insurance would be if it paid for oil changes, new tires, fan belts, etc. Yet that is the "regular maintenance" that many people expect from health insurance. If you were covered for an unlimited supply of test strips, the cost of the insurance would increase more than the $10 cost of purchasing the extra supplies you may need.

So it may be in your best financial interest to receive a limited number of test strips and pay for the rest yourself.