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Re: [IP] can anyone help?

> I am at my wits end!  I am from Missouri and I have Central Reserve
> Life(CRL) as my primary insurance.  I have been on the Disetronic
> Insulin Pump since 04-1995.  I now am trying to purchase a new
> D-Tron.  I also have to utilize the Healthlink PPO network. 
> Disetronic is not currently a Healthlink PPO (they are in the middle
> of contracting) So I have been working with Edgepark Surgical, which
> has been a horrible expierence!!!  CRL is telling the supplier that
> they will pay for a purchase of an insulin pump since it has been
> pre-determined that it is a covered benefit under my policy and that
> since this is not a rental option they will be paying the purchase
> price but in 6 monthly installments.  They will take the Healthlink
> contracted price and break it up into 6 payments to the supplier. 
> Well, guess what, the supplier(edgepark) will not do this because
> they have had 4 other patients in the past with CRL and it takes CRL
> 6 months to make the first payment and then they also cannot bill my
> secondary until the final payment is made.  I am outraged by the
> purchase price payment over 6 monthly installments.  Also if these
> payments fall into the next calendar year they will also have to
> deduct from those payments my calendar year deductible again even
> though the purchase happened in 2001.  At this point the purchase
> isn't going to happen because the supplier is regusing to provide
> this to me and there are no other Healthlink suppliers in this area
> to provide it to me.  I have talked until I am blue in the face.  I
> am physically ill over it.  My secondary is changing as of 01-01-02,
> which adds tons more issues to my problem.  I have talked to
> numberous people at the insurance company and NO ONE will help me. 
> One manager even flat out told me that they have been treating
> insulin pump purchases this way for 11+ years in this fashion and
> they aren't going to change now.  I have also made a complaint to
> the Dept of Insurance which will take months to hear from and I have
> spoke with an attorney for advice.  I am stuck between a rock and a
> hard place.  Even though this is a purchase and CRL has acknowledged
> that it is a purchase they are going to pay it in monthly(rental)
> payments. Does anyone have any suggestions or has anyone out there
> been through this?  You can email me at email @ redacted Thank
> You Laurie D.

Check the contract language to see if they are allowed to delay the 
payments. I suspect that this is probably not part of your insurance 
contract and if it delays you receiving treatment would be a 
violation of the agreement. See if you can get some help from the 
insurance specialist at Disetronic, contact the insurance 
commissioners office, etc..... but FIRST read the contract of 
email @ redacted
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