In most healthcare settings, the person receiving the service (the patient) is responsible to know or learn the benefits and coverage of their insurance plan.

Insurance codes and charges for services can change frequently.

If you are going to see doctor who is a diabetes specialist, your insurance company may require your primary care physician to refer you to the specialist. It is ultimately your responsibility to be sure the referral is completed before your first visit. The specialist's clinic my require you to sign a waver if they have not received the referral yet. Some insurance plans do not require your doctor to refer you to specialists, but the insurance company may have particular physicians/specialists who are covered in you plan.

To determine your out-of-pocket expense, check with the clinic and your insurance company for information about charges and coverage.

• What is the name of the service I will be getting?
• Is it an individual, or group setting?
• What is the length of time for each session or program?
• What are the charges for the service?
• Is the diabetes education program an "ADA Recognized Program" (required for Medicare/Medicaid coverage, and other insurance companies may cover recognized programs at a higher benefit level)?
• Are there any scholarships available?
• Is the dietitian a Medicare provider (for Medicare, nutrition counseling for diabetes and kidney disease is a covered benefit-only if provided by a dietitian approved by Medicare)?

When talking to your insurance company's customer service agent, knowing the charge codes for diabetes education and nutrition counseling can be helpful. 

• Do I have coverage for the type of education I will be receiving?
• Do I have a co-pay for this education, and how much is it?
• Do I have a dollar maximum for this service?
• Is my benefit annual, or lifetime?
• Have I used any of my benefit yet?

Medicare has recently made improvements in diabetes education and nutrition counseling benefits.

As of 2/28/2002:
For Diabetes Education, the first time you use the benefit, during the first 12 month period, Medicare will cover:

• 1 hour of individual diabetes self-management training

• 9 hours of group diabetes self-management training.

Each year thereafter, Medicare covers 2 hours per year of diabetes self-management training, individual or group.

For Medical Nutrition Therapy, for diabetes or kidney disease (not on dialysis), Medicare will pay for 3 hours of nutrition counseling the first year, and 2 hours per year thereafter.