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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 
insurance.
email @ redacted
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