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[IP] Need your opinion..again
The insurance for my pump has been approved! ...I think! I need your opinion
on whether or not to actually start with my pump instructor and use the pump.
My pump was certified as medically necessary on 12/24/98. After numerous
phone calls between the manufacturer and the insurance company (nurse case
manager) I was again told on 12/31/98 that it was approved and to "just check
with claims to see what percentage is covered." The case manager told me that
she could not discuss coverage. I was told by claims this past Monday
(1/4/99) that the pump was covered at 80% and would be paid. The claim rep
had just received the claim from the nurse case manager. I was told that I
had to still deal with the case manager, though. When I called her to see if
she thought it was "safe" to set up my appointments to get started with the
pump, she said "yes." Today I received a letter (which I had been told to
expect) telling me about restrictions on coverage relating to repairs, etc.
That part is OK. However, the letter then goes on to say that just because it
has been deemed medically necessary is no guarantee that the claim will be
paid. It states that the services must have been provided during the time of
coverage. Our insurance changed on 1/1/99. Although it did, I have a packing
slip showing that the pump was received prior to 12/31/98. I have a tape
recording of the message on my answering machine saying that the pump has been
certified as well as the letter stating that it has been certified. I know I
am probably being overly cautious, but I have a great respect for the POWER of
insurance companies and cannot afford to pay for this pump myself should they
now decline to pay the claim. Have any of your received a letter such as this
prior to the claim being paid? Was the claim paid without a lot of hoopla?
Is it safe to begin using my pump on the assumption that the claim will be
paid? Help! I have an appointment for my "hookup" with saline on Tuesday and
I need some guidance. You are all so helpful that I know I can count on you
for suggestions. Sorry this is so long. Thanks in advance for anything you
can tell me.
Insulin-Pumpers website http://www.insulin-pumpers.org/