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Re: [IP]Insurance Companies and Their Game

Sherry, get a Letter of medical necessity (it's late and wine. LOL) and send
it to them ( keep a copy).
-----Original Message-----
From: email @ redacted <email @ redacted>
To: email @ redacted <email @ redacted>
Date: Wednesday, April 07, 1999 11:22 PM
Subject: [IP]Insurance Companies and Their Game

>[sorry so long]
>hey guys, I am still looking into getting a pump,
>but decided to research into their policy before
>getting more excited about it. [Yeah, right.]
>Well they have their policy posted on the internet
>and its states the following:
>* Patient has insulin dependent diabetes (IDDM, Type I)
>* The pump is prescribed by an diabetologist familiar with
>insulin pump management.
>* Patient is capable of and committed to intensive insulin
>therapy, as demonstrated by achieving a HgbA1C of less
>than 9 while on multiple daily insulin injections.
>* Patients must be willing to monitor blood sugar at least
>four times a day, and follow prescribed eating and activity
>patterns. If a patient is unable to achieve reasonable control
>with injections, it is not likely that an insulin pump will improve
>blood sugar control.
>* A trial period with the pump, lasting one or more weeks
>(arranged by the physician or other mechanisms), demonstrates
>that the patient is capable of managing the pump.
>Ok, the first is pretty easy since I have been a type I for
>19 years now.  The third isn't bad since I haven't gone
>over 9 in over 6 years, and am on 3 shots a day.
>The fourth, is easy since I am already doing 5 tests a
>day.  I eat when hungry and play tennis actively.
>The fifth is after the fact, can't do anything about it now.
>The second however is the loophole.
>definition of diabetologist :
>diabetologist: an internal medicine doctor who has specialized in
>endocrinology, and further "subspecialized" to work with diabetic
>I am new to the area and figured why not find out first who in their
>network they consider to be a diabetologist before I get a new endo.
>When I called the insurance company the first time they reread me the
>policy and when I asked they told me to look in the providers handbook.
>[A phone book of doctors].  Ok, so I did.  No section on
>diabetologists.  However two sections of importance...Endocrinology
>Specialists and Endocrinology-Diabetes and Metabolism Specialists.  This
>should be a no brainer I know, but I got a really good recommendation by
>two people I have met here who love their endocrinologist. One is on the
>pump. The other is trying to be convinced.  But he falls under the
>endocrinologist section.  SO I called the insurance company a second
>time to see if these were the categories they meant and if doctors in the
>Endocrinology section would count too because of the "definition."  The
>woman over the phone told me and I quote: "Don't listen to the policy,
>it is a bunch of hot air.  All you need is a letter of necessity from
>your PCP and you send this to the pump providers and they work it out
>with us."  Seems a little to easy to me.  Makes me queasy.  I know they
>cover pumps, so why wouldn't I go to a specialist and follow the policy
>so they have nothing to turn on me with.  I need an endo anyway.
>Let me know what you think,
>Insulin Pumpers website http://www.insulin-pumpers.org/
>for mail subscription assistance, contact: HELP@insulin-pumpers.org

Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org