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[IP] Re: [IPy] Frustrated



>  Right now, my endo writes for 8 strips a day, but insurance is saying
>  I only
> get 200 strips per copay, so I get 25 days worth for one copay. If he
> wrote for ten per day, my guess is I'd get 20 days for one copay. I'm
> working on this. It's hard to get the people in the endo's office to
> understand what needs to be done to get the 30 days supply for one
> copay. I already had to switch back to one touch from contour because
> of this insurance - which is fine. Minimed supplied them under the old
> insurance, and I didn't have to deal with a limit.
> 
> Luckily I have a flexible savings account to help pay for stuff.
> 
> Stacey

I've done this over and over for Lily. This is what works every time.

Make sure you are talking directly to your insurance company, not the 
pharmacy supplier. The pharmacy supplier is a 3rd party provider 
under contract to the insurance co. If they provide you with strips 
over and above WHAT THEIR CONTRACT WITH YOUR INSURANCE CO. says, the 
don't get paid so their not gonna do it. You must speak with the 
pharmacy manager (or some similar title) at your insurance company. 
The try hard to screen the calls so you can't reach that person but 
if you persist you will succeed in reaching them.

1) Make sure the doc writes specifically that you are to test 10x per 
day so that if they don't want to do it then they are "practicing 
medicine".... and you can ask the question "are you telling me what 
my medical care should be"? "are you practicing medicine"

2) ask specifically where in YOUR COPY of the contract of insurance 
it says that strips are limited to (whatever). Make sure you read the 
section on diabetes supplies so you can quote it back to them with 
the page number and paragraph number.

3) definetly appeal TWICE. Make sure you document the time and date 
of each contact and exactly who you speak with. There is no 3rd time. 
The third time goes directly to the state insurance comissioner with 
a complaint that your doctor has prescribed specific medical care 
which is covered by your policy (quote page and paragraph and include 
a copy) and they have refused to provide the care ... and in addition 
that they are practicing medicine by countermanding the doctors 
specific orders.

Of course, the third letter will never be written because they will 
cave in. KEEP the records for each time you have to do this so that 
you can quote back to them next time, the dates, who you talked to, 
the dates of appeal, the outcomes, etc.... after a few time, they 
will probably stop hassling you because they will figure out that you 
are not an easy mark. I've had to do it 4 or 5 times over the years 
but it all stopped about a half dozen years ago.

Michael
.
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