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Re: [IP] Insurance is backpedaling on paying

Hi Kasey,

I use a logbook called "My Other Checkbook."  Each day's records are on
a separate page.  You might consider transferring Kayla's records to a
book like that.  Then threaten to FAX that (approximately 180
pages/documents) plus everything else you can get your hands on from
doctors, nurses, CDE's, etc.  They probably won't want to wade through
that many pages of documentation.  They also probably won't want their
FAX machine tied up for that much time!  Sometimes you just have to play
the game their way -- DIRTY!

Good luck.

<< Okay gang, I need some help here.  My insurance company is doing a
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.


Kasey >>


	... Sue  :-)

		For a healthy heart ...
		Give your Faith a workout!

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