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Re: [IP] Feedback, PLEASE (insurance approval troubles) !!

Laurel & Wayne Sedgwick wrote:
> I've been lurking and reading, learning a lot from you folks, while waiting
> for my insurance to approve a pump for me.
> Today I got a call from the Minimed pump rep, saying that my insurance
> would grant approval for one month ONLY, or not at all.  At that point, I
> have to send them the records of my BGs for that period (they already
> demanded--and got--my records for a month of pre-pump), and they will pay
> for me to keep the pump then only if *they* decide that my BGs have
> "improved enough" using the pump to warrant their doing so.
> Is this a normal stipulation for an insurance company to make?  It sure
> doesn't seem reasonable to me.
> I have no idea what their criteria are, and I'm afraid they'll just
> arbitrarily take the pump away from me after a month.
> I called my endo and she said she would contact her pumping rep and see if
> he could get my insurance company to agree to an extension, but the person
> I spoke to said they had already tried negotiating with the insurance
> company, and the company was very adamant that this was the only way I
> would be approved.
> To say I am bummed is an understatement.  I really don't want to start on
> the pump (a fairly large and emotion-laden step for me) with no sense that
> I (and my doc) have any control over what ultimately happens.  I realize
> it's possible that pump use might not give me a better handle on my DM, and
> I'm willing to take *that* risk, but what if my doctor and I think it's
> helping, and the insurance company disagrees?
> I am not an unusual candidate for a pump; in fact, I fit the profile of a
> candidate who needs, and is likely to be successful with, a pump.
> I  really need whatever encouragement and advice you are able to offer.
> I've been sick for nearly three months now with a cough that just won't go
> away, even though I've been to the doctor, followed her instructions and
> been through 3 rounds of different antibiotics; and to the chiropractor and
> gone through detox.  I had a chest x-ray last week and it was clear, but my
> chest has been hurting like crazy for the past three weeks (virtually every
> step and breath causing it to throb), and it doesn't seem to be getting any
> better.  I've continued to exercise (mildly) because I know if I don't my
> BGs will go wild, but I could make it around the track today at lunch-hour
> only through sheer will-power, and at work I'm hanging on by my
> fingernails.  My morale is really low from fighting this chest thing, and I
> don't feel able to fight the insurance company too.
> I feel like a wimp and hate to bother everyone, but I'm also a little
> desperate.  Any advice or thoughts you have to offer will be most
> appreciated.
> TIA,
> --Laurel
> Type 1 for 23 years
> Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/

Dear Laurel:

I don't know if that's normal; I use CIGNA Healthcare, an HMO. I live in
Orlando, FL, and under our state laws, ANY HMO or insurance policy sold
in the state MUST cover ALL medically necessary supplies and services.
Even without that law, CIGNA's benefits cover pumps, once the primary
physician tells them that it is necessary for the patient. Once CIGNA
approves you, you're covered, no "we'll see if we let you keep it" bull. 

You may want to contact your local consumer agencies, and ask them if
your insurance firm is allowed to do this. Florida has an office that
deals specifically with consumer insurance problems.

I hope I have been of some help.


Amil Vazquez Jr.
Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/