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[IP] Insurance story

Ryan Wrote
I never recall suggesting such a thing. But if EVERYONE always got the best
medical treatment available, medical costs would be so prohibitive, NO ONE
could afford medicine nor the insurance premiums to cover it.  But, if an
insurance company is, in fact, denying medically necessary coverage...then
something is wrong.  Take test strips as a small example.  I'm sure I could
get better control if I tested 15 times a day instead of the 8 I do now.
But, should an insurance company be required to pay for almost twice the
strips when the difference I would improve would not be medically
Let me tell you a short story on my experience with my insurance(who shall
remain nameless)
In October at my last visist to my ENDO he recommended I should go on the
pump. He thought with my work schedules(2 of them) and my active lifestyle the
pump would give me more freedom and tighter control. He wrote a letter of
medical neccessity and they approved the pump. My cost were to 80/20 being
covered as "Diabetic Supplies". Well.....since I figured i had a deductible to
meet every year why not wait until the new year and then in one shot I would
meet my deductible and get my pump and the supplies would be at 20% the
remainder of the year....Smart move right?
The insurance companies(All that have coverage in SoCal) have changed the
definition of the pump to "infuser,home,insulin pump" It now is a durable
medical good...like a wheelchair or crutches. Now it is a 50/50 cost split and
a 2K cap on what the insurance companies will cover. My out of pocket went
from $2000. to over $4200.00 plus now i have to pay full price for supplies.
Well I will tell you that dealing personally with the beuracratic morass of
the insurance companies is a nightmare. Mt entire company is switching from
this company to another one because of this. Everyone I work with and for
supports my efforts to maintain my health and is behind me 100%. The new
insurance company is still 50/50 but with no DME cap.
Just needed to vent

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