[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IP] Insurance is backpedaling on paying

Letters of medical necessity from your endo should be submitted, describing
how the pump will end the threat of hypoglycemia to your little girl.

Other than that, I'm sure they'd like to see the logs, and I'm also sure the
logs are better than pre-pump logs they should also have requested...

I think they'll probably let your daughter have one.

-----Original Message-----
From: Kasey Sikes <email @ redacted>
To: email @ redacted <email @ redacted>
Date: Monday, July 06, 1998 8:10 PM
Subject: [IP] Insurance is backpedaling on paying

>Okay gang, I need some help here.  My insurance company is doing a major
>song and dance now about approving the pump for Kayla.  For those of you
>that need refreshing, here's a little history:  Kayla is 5.  Our
>insurance company (Government Employees Hospital Association) has never
>had a diabetic that young requesting a pump, so they decided to pay for
>a 6 week rental, first.  If at the end of 6 weeks Kayla still wanted the
>pump, they would pay for it.  Sounded fair to me and I made sure to ask
>point-blank, "What do you expect to see in those 6 weeks?"  They assured
>me they weren't looking for any changes, only that she was still using
>the thing.  They didn't want to shell out $5000 clams for something that
>sat on the bedroom dresser.  Made sense to me.
>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.
>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.
>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.
>email @ redacted
>Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
>For subscribe / unsubscribe information,
>send the next two lines in a message
>to the e-mail address: email @ redacted

Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
For subscribe / unsubscribe information,
send the next two lines in a message
to the e-mail address: email @ redacted