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Re: [IP] Insurance Snag

On Wed, 10 Feb 1999 email @ redacted wrote:

> Does anyone else have a child on the pump under 13 and has Trigon Blue
> Cross/Blue Shield?????
> Apparently we have NOW heard that Trigons policy states the child must be 13,
> and insulin dependant for 1 year. Kevin is going to be 11 in one month, and
> only D since Dec. 98....but he is very VERY independant and trustworthy. I
> plan to fight this. They said to submit the letter of necessity anyway and
> they will still put it through to the Board for Review!   Our Endo is ok with
> it, Kevin is ok with it (most important) and we are VERY ok with it....why
> isn't insurance???   I wish I understood.  
Unless it is specifically spelled out in writing in your policy, you will 
eventually win this battle. Do not give up. Their refusal is without 
grounds. Insulin Pumps are NOT experimental devices, but rather are 
an accepted standard method of treatment for Type 1 diabetes. If it is 
ordered by your physician, your insurance company is obligated by the 
terms of the policy to provide the benefit unless it is specifically 
excluded. Take them to task on this. Move immediately to the appeal phase 
and demand and immediate answer in writing. Don't fool with the 'helpers' 
but talk directly to a senior appeals person. Make it clear that absent 
an exclusion in your policy, you will be contacting the state insurance 
commissioners office and your attorney if they fail to provide the 
benefits stated in the policy (which is just about anything not 
specifically excluded if it is "standard").

Insulin-Pumpers website http://www.insulin-pumpers.org/