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Re: [IP] insurance recourse?



DD:

One thing which rankles me is when doctors and insurance companies describe
someone as "poorly controlled". It is amazing the range of responses you
will get if you ask those persons to define what they mean by "poor control".

How does the insurance company define the term? How do you and your doctor
define control? How does the DCCT define control?

Knowing the answers to these questions (hint - there are no right or wrong
answers here) can have a substantial impact on the argument which you and
your doctor present to the insurance review committee.

I know a number of people who have had to educate their doctor as well as
the insurance company. I know of some folks who have "fired" their
physician because they felt less than adequately represented by the doc.

If your doc is getting complacent because his / her first pump patient may
be more of a challenge than they have experienced in a while - *tough*. No
one should ever have promised them that a career in medicine would be a
cake walk.

Try not to despair if your first efforts meet resistance by the doc and the
insurer. It may take a little longer than you want, but if the facts are
supportive, you may be able to craft a solution out of this.

Bob Burnett
mailto:email @ redacted

>Forrest,
>     My doctor doesn't want to let me have the pump because no one she is
>working with is on the pump.  She also doesn't believe that the company will
>cover it.  When I called the company they said the only issue the pump if
your
>control is poor.  So the logic here is if you're a lazy diabetic you will get
>the pump.  Thanks, DD
>