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Re: [IP] Insurance company co-pays

File an appeal or at least learn your rights!

I appealed the original denials of my husband's insulin pump, and later the 
denial of coverage of his pump supplies (they said there was no medical 
evidence of better control with a pump, and called it a luxury item!).  The 
appeals process should be defined in your benefits brochure, and that should 
be available from your personnel department.  My personnel department 
communicated directly with the carrier, and Todd's pump and supplies were 
quickly covered.  

He gets his supplies via the mail order pharmacy, and this year, ours is also 
doing this "higher co-pay for non-generic prescriptions".  It's a significant 
difference, too, and they currently say they don't care if there's no generic 
equivalent available... it's still the higher copay.

We haven't pursued this issue yet, and if/when we do, we'll let you know.  
FYI, in the first denials on his pump and supplies, our personnel office had 
no knowledge of the carriers practices, even though the carrier was accusing 
the personnel office defining the benefit!  I don't think they ever expected 
anyone would argue with them.  Fair warning:  It took a lot out of me 
emotionally, and time-wise, arguing the obvious with the carrier.  On the 
other hand, the insulin reactions did too!!

It's probably worth at least asking (in writing) for confirmation and 
clarification of the benefit limitation, and pursuing your appeal rights.  

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