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Re: [IP] Those @#$% Insurance Companies!

RoseLea -

Don't lose hope just yet.  I know it's frustrating.  I just recently found
out that I will be getting a pump soon, and the only reason for it is the
health insurance we have through my husband's federal gov't job.  It will
cover 90% of the cost after our deductible, as long as I meet the
'criteria' - more than two injections a day (yep) suboptimal HbA1C's (yep -
last one a 7.2) and an attempt to exercise and follow diet (yeppers).
Needless to say I'm thrilled that they will cover the pump and it's

On the other hand, I've been fighting for two years to get a pump.  The
first year, I was in college on a college based health insurance plan that
basically laughed at me when I asked if they would cover test strips (2 a
day - sorry charlie, that wasn't gonna work - I test my sugars at least 8
times a day, so it was gonna be nice to know where the other six were going
to magically appear from).  As you can imagine, the same with the pump.  I
then worked for the university for a year, and had state gov't insurance -
same sort of story.  My doc wrote a prescrip for the test strips  -  8 a
ay  - and I only rec'd four a day when the scrip was mailed to me.  I was
also told that they would only cover two of my insulin types (at the time I
was using three).  Now the kicker - when I halfheartedly asked about the
pump, they said they needed 'proof' that I would be better off on it than
MDI.  Excuse me?  I would initially be responsible for paying for the doc
visits, the pump, and supplies, and if  a year later I could prove that
things had improved they would then pay their part.  I'm sorry, but things
like that are a bunch of bull****.  They are too worried about laying down
the money to let us take care of ourselves - and they end up paying dearly
for it in the end.  (Sometimes.  Sometimes you are told that since it was a
'pre-existing condition' they don't have to cover anything because of it.)

Like I say, now things look like they are going to work out fine, but I
wouldn't give up the fight just yet.  You need to make a point to your
insurance company, wether it be by sending them literature, asking if they
are aware of the DCCT (most companies will only give four test strips a day
because that meets the 'minimum req'd by the DCCT.  MINIMUM is the key word
here.)  I wish you the best of luck.
----- Original Message -----
From: RoseLea <email @ redacted>
To: <email @ redacted>
Sent: Friday, January 14, 2000 7:16 AM
Subject: [IP] Those @#$% Insurance Companies!

> Ah, now the truth is out about our new insurance coverage.  No matter what
> the salesman told my husband's company about the coverage and how great it
> will be... it was all hogwash!
> They have told me that for medical supplies, I need a prescription to have
> it covered.  Ok, I can do that.  But now here's the clincher.  For test
> strips, even if my doctor recommends that I test more frequently, they'll
> only cover 100 strips per month.  That figures out to only about 3 tests
> day!  I do more than that now on MDI!  How am I suppose to know what my Bg
> is doing on only 3 tests per day?  And, my doctor has already told me that
> in the beginning of pumping, until things are worked out, he prefers
> every 2 hours, that's 12 times per day!  So now I have a new doctor.  It's
> called BC/BS Community Blue PPO.
> I'm so upset, I just ate a Suzy Q!  Well, I guess we'll let them see how
> they like paying for hospital stays rather than test strips.  I give
> RoseLea
> Type 1 for 37 years, probably won't be pumping at all...
> ----------------------------------------------------------
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