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Re: [IP] Insurance is backpedaling on paying



Kasey Sikes wrote:
> 
 They assured
> me they weren't looking for any changes, only that she was still using
> the thing.  

Do you have that from them in writing? (I hope!) If so FAX it to their 
office every few minutes. That should get them ready to quit the silliness...

> Now we're nearing the end of the 6-weeks, Kayla still wants the pump
> (but only in cool-blue ;)), and now GEHA is wanting copies of her bg
> logs for the last 6-weeks.  They want to make sure the pump is
> controlling the diabetes.  When the lady on the phone told me that, I
> wanted to crawl through the phone and strangle her.  Kayla is doing
> 'better' on the pump, but it's not great, yet.  And those boneheads
> don't know anything about 'learning curves', etc.

As I understand it excellent control is EXPECTED to take ANY diabetic 
6 months to a year, regardless of age. Actually Kayla should do better than 
that, she doesn't have as much to unlearn.

> So, here's where I am.  They lied.  (Surprise, surprise)  I don't want
> to send the bg logs just because that wasn't an original stipulation.
> If they had made that demand from the get-go, I would have postponed
> putting Kayla on the pump and fought them for approval.  Now we face the
> possibility of being forced to go back to MDI if they deny it and we
> have to fight them over it.  I cannot afford to rent a pump myself.

Ask them repeatedly why they wish to decrease the better control she's gained
using the pump so that she can develop very complicated, expensive, and likely
disabling complications sooner than necessary for lack of them following
through on their promise she would have the pump if she still wants it
after the trial period. After saying that ask for the persons supervisor.
Tell him or her, then ask for THEIR supervisor. Call several times a day
and saturate their office with the need to approve the pump.

> I'm wanting any and all suggestions for nipping this in the bud and
> getting them to stand by their original promise - if she likes it,
> they'll approve it.  I'm ready to get 'down and dirty' if need be, but
> would like advice from those who've 'been there, done that'.  And any
> legal advice would be nice, too!  :-)  I know they don't put other
> diabetics through this process; they are discriminating against her
> solely because of her age.

As I said originally, if they put it in writing before she started the trial
be sure to tell all and sundry that you will have a lawyer contact them.

Ted Quick
email @ redacted 
> HELP!!!
> 
> Kasey
> email @ redacted
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