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Re: [IP] Coverage



The national BC/BS changed their DME as far as pump coverage goes
effective April 2003.  They will no longer automatically cover type 2s
for pumps.  In fact, they will reject the claim out of hand.  Your
doctor will have to file an appeal and better have a very good reason
to justify the pump.  I had gotten an IR-1000 before they had changed
the rules.  My endo decided that he felt that I needed the finer and
lower basal dosage of the IR-1200.  Anthem BC/BS rejected it initially
because I'm type 2 and said that because of their change of policy
they would not grant the pump.  My endo had to put in an appeal and it
involved a lot on his part to medically justify the IR-1200.  So just
a word of warning.  And Anthem just merged today with their California
counterpart making them the largest health insurer in the US.  So
beware, because in the way of cutting costs for health care, pumps are
big ticket items and when companies look at ways to cut the health
insurance costs that is one of the first things that will be cut from
coverage.

Bruce


On Wed, 1 Dec 2004 19:00:04 EST, email @ redacted <email @ redacted> wrote:
> 
> 
> I
> 
> It depends on what type of plan you have with BC/BS, but overall BC/BS pays
> for all brands of pump and does not require jumping through numerous hurdles.
> Good luck!
> 
> 
> .
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