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Re: [IP] Pump for type 2

> Date: Mon, 31 Dec 2001 23:17:34 -0700
> To: Insulin Pumpers <email @ redacted>
> From: Neil Hejny <email @ redacted>
> Subject: Pump for Type 2
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> I've recently joined the group, and have quickly found a wealth of
> knowledge available here. I've been diagnosed Type 2 since 5/99.
> I've been diagnosed IDDM since 2+ weeks ago, and am taking Humalog
> w/ each meal and snack, and Lantus at bedtime. I'm already tired of
> injections!
> I contacted Minimed to get info on their 508 pump. They volunteered
> to determine if my insurance company would pay for a pump. They told
> me that since I am Type 2, the answer is "no".
> Any thoughts on how I can convince my insurance company otherwise?
> Thanks in advance for any suggestions. Regards, Neil

The argument to the insurance company is the same whether you are 
type 1 or type 2. Unless there is language in the contract of 
insurance that expressly excludes insulin pump therapy, they must 
pay. The may give you all kinds of BS about why you are not eligible, 
but if your doc writes a prescription and letter of medical necessity 
then they must comply. Go through all the necessary motions, send in 
the prescription and letter of medical necessity. Ask for written 
refusal AND the reason, then take them back to the contract of 
insurance and ask where it say that pumps are not covered. They will 
attempt to give you all sorts of "internal" criteria why you are or 
may not be eligible, you merely have to bring the back AGAIN to the 
contract of insurance and ask AGAIN where is says that pumps are not 
covered. Be prepared to appeal, then appeal a second time (there are 
usually two levels of appeal with most insurance companies), then 
appeal to the state insurance commissioner. At all times, make sure 
the ins co understands that you will NOT accept no for an answer and 
that you plan to appeal and carry the matter all the way to the 
insurance commissioners office. Remind them about countermanding the 
doctors orders and how that constitutes practicing medicine which we 
all know is contrary to all state and federal laws.

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