State RegulationsCO specificDifficulty 3/5
A Boulder resident's individual health policy covers diabetes equipment and supplies but denies her outpatient self-management training because no provider prescribed it. Under C.R.S. § 10-16-104(13), is the denial proper?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under C.R.S. § 10-16-104(13), outpatient self-management training and education, including medical nutrition therapy, is a mandated diabetes benefit when prescribed. The denial is improper: the insurer may apply the same deductibles and copays as for other benefits (and see also C.R.S. § 10-16-151), but it cannot refuse prescribed training and education.
Why the other options are wrong
- A) Training is a mandated benefit, not an optional one.
- B) The mandate is broader than equipment and supplies; it expressly includes training and education when prescribed.
- D) Coverage is subject to the same deductibles and copays as other benefits; there is no zero-cost-sharing rule.
Memory hook
Prescribed training must be covered — same copays, no denial.