[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IP]Insurance Companies and Their Game

Thanks.  But I actually want to see an endo anyways.  making an appointment
tomorrow. but I have a reference number to the conversation which was taped.
The name of the individual who told me that.  And outstanding notes on my
healthcare. :-)
I am ready for them.

-----Original Message-----
From: footprnt <email @ redacted>
To: email @ redacted <email @ redacted>
Date: Wednesday, April 07, 1999 11:43 PM
Subject: Re: [IP]Insurance Companies and Their Game

>Sherry, get a Letter of medical necessity (it's late and wine. LOL) and
>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

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