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RE: [IP] Insurance denial/my right



I am covered under Guardian Health Insurance and they pay for every thing my
daughter needs including pump batteries.  Every three months I receive all
supplies needed no questions asked.  My husband has HIP and they help out
also with some of it.

> -----Original Message-----
> From:	The Tarca's [SMTP:email @ redacted]
> Sent:	Monday, January 14, 2002 2:45 PM
> To:	email @ redacted
> Subject:	Re: [IP] Insurance denial/my right
> 
> ....44 states require insurance companies to pay for diabetes supplies,
> all
> except Alabama, Idaho, Montana, North Dakota, Ohio, Oregon....
> 
> However, in the state of Connecticut, if your employer is self-insured
> (also
> called self-funded), they do not have to cover much.  If the employer
> purchases their insurance from an insurance company, there is no cap on
> diabetes supply costs.  My employer (a hospital) is self-insured, and was
> only going to pay for $300/year for pump supplies (under "medical
> supplies").  My husband's employer (also a hospital), is not self-insured,
> and with our HMO coverage thru them they are covered at 100% with NO CAP
> (under "durable medical equipment").  Under my husband's plan, pump
> supplies
> are considered DME, and there would normally be a $1500 cap per year but
> because of our state law, there is no cap for diabetes supplies.  However,
> once we reach the $1500 per year, if my son needed some other type of
> equipment covered under DME, we would have to pay for it.  It's very
> complicated.
> 
> All I know is, that I am grateful for the coverage we have...the HMO also
> pays for blood testing strips at 100% (and they've never questioned the
> brand or amount), and we receive 3 months supply of insulin at a time for
> only a $30 co pay.
> 
> The interesting thing is - my hospital and my husband's hospital both have
> the same insurance company.  See what a difference policy variations can
> make?  My employer has a self-funded PPO plan and my husband's has a
> purchased HMO product, both from MedSpan.
> 
> Sharon
> Mom of Steven, almost 16, and a very happy pumper since July 7, 1999
> ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> send a DONATION http://www.Insulin-Pumpers.org/donate.shtml


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