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Re: [IP] Insurance Denial

> My six year old son Eric was just denied coverage for an insulin
> pump by Blue Cross of North Dakota. The denial came after they
> conveniently lost the request and had to have everything
> resubmitted.   The request was denied because their criteria say you
> have to be at least 12 years old and he is too well controlled.  I
> can only laugh at their reasons.  He is well controlled because we
> give him 3-6 injections a day. I have been told that 2 children
> under the age of 12 have had pumps covered by this insurance
> company.  Does anyone know these kids?  Any other suggestions? 

It is pretty common for insurance companies to deny coverage 
initially. The best tactic at this point is to go after them again. 

First Question: Where in the contract of insurance does it say that 
candidates for an insulin pump must be 12 or more years of age??

They will try to divert you in to arguments about hba1c's being to 
high or low, age (again), control, number of bg tests, etc.... these 
are all spurious arguments to draw your focus away from the 
CONTRACT OF INSURANCE which you can be sure says absolutely nothing 
about age or any of those other things. 

What is required is a doctors letter of medical necessity

Second question: Is the insurance company contravening the physicians 
order and letter of medical necessity. IS THE INSURANCE COMPANY 

I'll send you more privately.

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