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[IP] Insurance woes...kinda long

Hi all.  I said I would keep folks 'up' on what's going on with the
insurance process for me (I know some of you have written me asking
what/how/ etc.   with it).  It appears that things aren't going to go as
easily as I first thought they would.

When I first started this whole process, I called the insurance co., and
asked what they would cover, and what they needed for me to do to get the
process started.  I was told they would cover 90% of the cost, as long as I
went through a preferred provider, and that what I needed to do was provide
'proof that you are following a diet (yes, I keep 'food diaries'), proof
that I was on more than two injections a day (yes, 3 to 5 - also keep that
in my logs), proof that my last HbA1C was over a 7.0 (yes, 7.2), proof that
I follow an exercise regimen (yes again - logs), and proof that I have
erratic blood sugars (yes again - and again all included in my logs).  So, I
turned all of this info into my CDE and endo, who said there shouldn't be a
problem at all with me getting the pump.  I showed motivation and need, and
I had all the records showing it.  (please note I turned in about a months
worth of my paperwork and records at this point).

Well, I filled out the paperwork to send to Disetronic regarding insurance.
I got a call back on Monday from the insurance coordinator at Dis, who told
me that BC/BS decided they would only cover 75% of the pump cost because
Disetronic itself is considered to be 'out of network;'  - didn't matter if
I was going through a preferred provider or not.  I almost choked on that
bit of information, seeing as that if we had that much money to spend, we
would get a car that was worth more than $800.  <VBG>.   Dis then told me
that they would give us a discount on it to help match the 90% part, for
which I was greatful for.  He also told me that he would be faxing my CDE
some info on things they needed us to work together on for the insurance

Okay, got this so far?  My CDE called yesterday.  She said they should have
just faxed it all to me (she wasn't being mean about it  - she was more or
less being sarcastic towards the insurance company since everything they are
requesting starts with me).  She said that now they want the following:  the
last 3 to 4 months of dietary, exercise, insulin, and glucose logs; proof of
at least 3 HbA1C's over a 7.0; proof of continuing dietary education;
doctors records for the last six years showing proof of poor sugar control;
and any other proof that a pump would benefit my needs over MDI.

Here's where my problems are.  A)  Hubby and I are both recent college
students, never had two pennies to rub together for anything.  I had one
HbA1C done in '94, which was a 6.9, and my recent one of a 7.2.  (We had
horrible insurance through school - wouldn't cover anything diabetes related
thanks to the 'pre-existing condition' clause, and when your broke, you
don't have money to spend on docs, etc. ).  So, there's strike one.  I don't
even have three to give them, and one is below a 7, the other to them is
still considered within normal range.  Strike two:  My last three months of
logs are all written in one of those tiny little testing diaries that comes
with your meter; it's all chicken scratch that only I can decipher; it does
have how many carbs I ate, and whether or not I exercised, but is very
rudimentary.  Strike three:  the only FORMAL dietary education I've had was
when I was a three year old; I've learned everything from my mother, my
father, and from whatever I've been able to get my grubby little hands on
and read.  I was taught how to carbo count at diabetic camp as a kid, and
every summer I counsel there I get a meal plan according to the number of
calories I normally eat.  I am a smart person - I know how and what works
for me, and I read up on it as much as I can.  Again, I could never afford
to see a dietitian so she can sit me down and tell me the same d#%* thing.
Only thing going for me right now is that I've lost pregnancies, probably
due in part to sub-optimal control.

So, here's what we did.  I sent the log with a deciphering 'cheat sheet'; I
sent all of my recent stuff I've been keeping on the computer; I sent the
last meal plan made for me at camp, along with a lengthy history of what I
learned and from whom/where; a rather lengthy letter stating why I felt a
pump would have helped with previous pregnancies, and what kind of hope I
hold for the future with one.  They said they would also like 'some back
logs of sugars from the previous four years' - excuse me again, but when we
moved out of state recently we cut all the fat, if ya know what I mean -
what the hell did I need four years of old testing logs for, and why did I
need to drag them across a couple of state lines?  Now I'm afraid they're
going to tell me that there isn't enough proof to show I need a pump.  I
stayed up until two in the morning last night finding all of this crap, and
worked on it from 8 to 3 today!!!  I'm so hoping that I'll hear something
positive back.  My 'little bit of documentation needed' turned into 'we need
a heaping pile of documentation or you won't get it.'  Sigh.  I won't let
them break me, though - and this is just to let everyone know that I won't
take no for an answer!  Insulin pump, here I come!!!!!!!!!!!!!!

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