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[IP] Insurance Coverage Survey

Hello Insulin-Pumpers,

My name is Bridget Martin.  I am a pumper and a law student.  I started
pumping in Dec. 1999. I have been "lurking" on this list for a while now. 
While in the process of getting my pump, I learned first hand how hard it
can be to get insurance approval for your pump.  I have also been very
interested by the various posts on insurance woes.

I am now writing a paper for my "Law and Medicine" seminar.  My topic will
deal with denial of coverage and the definition of "medical necessity".  I
am also going to explore what rights an insured party may have against an
insurance company that seems to be trying to practice medicine by forcing
the insured party to go to extreme measures to show that the pump is a
medical necessity.  

Please take the time to answer the following questions for me.  I know
this is a bit long, but I am trying to look for some specific patterns and
practices among insurance companies.  I am especially interested in anyone
who may have been told that their control (or HbA1c) was "good enough" on
multiple daily injections so they didn't really need the pump.  I will try
to post a copy of my paper to the list once I have finished.  Thank you so
much for your time.  

What Type are you (1, 2, 1.5)?

What was your date of diagnosis?

What was your age of diagnosis?

When did you start pumping?

What was your HbA1c immediately before pumping?

What was your HbA1c post-pump?

Have your HbA1c's continued to improve?

What is the name of the Insurance Company you were with when you started
the pump?

What form of insurance was/is it (HMO, PPO, etc)?

How long did it take your insurance company to process your claim for the

What documents (blood glucose records, medical records, meal logs, etc.),
if any, did you have to submit to your insurance company?

How does your insurance company classify the pump (durable medical
equipment, prescription, etc.)?

Briefly describe the process you went through to get your pump approved by
your insurance company?

If your insurance company tried to deny approval, did they state a
specific reason?

If you had to appeal a denial of approval, do you know if it went before a
medical review board of some sort?

Have you ever seen a copy of the actual contract that you insurance
company has with your employer (the contract they use in explaining why a
pump would not be covered or in explaining to what extent something will
be covered)?

Does your insurance plan cover pump supplies? If you've been on various
insurance plans since pumping, please inform me of what each plan covered.

How much is your co-pay for pump supplies?

Does your plan consider pump supplies a prescription, durable medical
equipment or something else?

Do you feel your diabetes management has improved because of the pump?

Do you mind if I contact you to ask you further questions about any of
your answers?

Please feel free to provide any other information you feel would be

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