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Re:Re: [IP] hope to be pump user

Spot wrote (in quotes):
"I was unaware that the insurance companies obtained a license to practice
medicine in any state except confusion. Seems to me, If your doc ordered it,
they have to pay for it if they like it or not."

Again, what did the insurance contract (as set by the employer) say?  No one
is saying the person couldn't have a pump, just to show proof that other
means to control glucose levels had been unsuccessful (believe us, we wish
anyone who wanted to have a pump could just by asking, but remember our
recent post about Medicare criteria to have Medicare give 80% coverage on
the pump/supplies?  These are the same criteria which are used by many
insurance companies).  Then again, there's always buy your own, isn't there.
There are many items covered by different health insurance companies where
prior approval is required from tests to surgeries to specific medications
(read: formulary where if you want something not covered, it's buy your own
or if you're lucky, only a large co-pay).   Like it or not, these are some
facts of life and having health insurance.  Knowing what your state law is
as to coverage of diabetic supplies is the first place to start, knowing
your contract it the second.  Some insurance companies cover diabetic
supplies at 100%, others have deductibles and/or co-pays of varying
percentages or dollar amounts (often quite high).  Some require the use of
specific supply businesses for coverage, require specific types of equipment
to be used to be covered, and again if you don't like it, there's always buy
your own.

"I guess when premium time rolls around you might tell them I don't want to
pay the premium, Its a lot of money. How would they react to that?"

No "skin off the insurance company's nose"-you don't pay premium, they don't
insure-very simple.  In fact, they'd probably love it if someone with a
chronic condition lost coverage due to non-payment of premiums.

"there are lawyers who just do this kind of law, they love cases like

Only if your state law for coverage of diabetic supplies or insurance
contract so support (we have a lawyer in the family who has/does deal with
just such issues-not so cut and dry as it sometimes seems, and, of course,
lawyers won't say no to taking your money...).  It's important to  know the
appeals process for your insurance, what's required in the appeal, time
frames, etc.

Marj; Mike (I'm not into computers, but glad to be on this list); and "Ace,
the PP" (portable pancreas)
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