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[IP] insulin-pumpers-digest V7 #63

>Pumps (as well as any other durable medical equipment) are specifically 
covered under our policy, "when medically necessary."  My doctor has already 
written a letter of medical necessity.  Aetna should not be allowed to 
override that decision.  They are [not?] licensed to practice medicine in the 
state of Iowa, or any other state that I am aware of. If that approach does 
not work, I can always sue them for fraud. Failing to provide coverage that 
is written in our policy constitutes fraud.  Several of these lawsuits have 
been ruled in favor of the insured already.

 If the pump is denied, you can write a letter back to Aetna in response to the
denial outlining your attempts to achieve the tightest control possible with the
use of a pump and stating that you think it is unfortunate that they have denied
this "medically necessary intervention that could preserve your long-term health
by delaying or preventing chronic diabetes complications". I don't think their
legal department likes to have this kind of documentation in your file and will
usually give you an approval rather than be looking at a potential law suit from
you down the road.
Leigh Steed, RN, CDE
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