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[IP] RE: insurance woes ( long reply)
You're giving me deja vu. Getting a pump out of my insurance company is
a traumatic and repressed memory for me. But you know, I won in the end, and
I can tell by your determination, you will too. It's just a question of how
much BG-raising stress they intend to heap on you between now and then.
I look back on my fight an wished I had done some things differently but
since I did get my pump, I'm not sure what I base that on.
Among the things I did, not all of which I am proud of: I called them
every single day, sometimes multiple times in a day, for the entire month it
took to get approval (I didn't have it so bad, only a month-long fight); I
faxed them 45 pages of documentation and my PCP's office faxed them about 30
pages (while I had hoped this would overwhelm them with the evidence of my
need for the pump, what they actually did was sift my data for anything that
supported their contention that I didn't need a pump -- so evidence is at
best a two-edged sword, and a worst, a weapon they will turn against the
petitioner); Here comes the part I am not proud of ---> One day I was on
the phone with the insurance person, the one who is a step outside the
Insurance company's medical director. She said the pump would be merely a
convenience to me, and buttressed her contention by citing an article I had
down-loaded from Insulin-pumpers and sent on to them. I lost my -- uhmmm --
equanimity. I screamed at her that I would like the convenience of a working
pancreas, that I would have liked the convenience of being able to see
clearly out of my two eyes, damaged now by years of laser surgery for
retinopathy; that I would like the convenience of being able to finish an
interview with a source or sit through an unexpected lunch-hour meeting
without going into insulin shock. It was quite dramatic. I was sobbing and
shouting, and I'm ashamed because it wasn't staged. I was totally outraged
and out of control.
The only good thing that came out of the emotional explosion of a phone
call is that I developed an indignity that these people who had never laid
eyes on me were making decisions about my care based on pieces of paper. No
doctor worth his degree will prescribe treatment over the telephone and yet
these people were presuming to decide on my treatment. I never sent them
another piece of paper, realizing this amounted to a tacit acknowledgement
of a right to treat a person they had never seen.
Following that horrible phone call, (and I continued to call every day) I
did have approval for a pump within a week, but I don't know which of the
things I did helped or hurt.
Here are some things you might want know, for the purpose of lining up
your ducks. Does your state allow you to sue your insurance company, or HMO?
What is the telephone number for your state's insurance commissioner, and
what is the process for filing a complaint against an insurance company? You
don't have to act on this now, just know it.
Also, you have lost babies to sub-optimal BGs? and that isn't enough for
a pump? I wish I was a lawyer. I bet I could get rich off your case. Tell
them you need to have optimal BGs because you are planning on getting
pregnant, because you are, right?
Sic 'em Dawn. I'm rooting for you!
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