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[IP] Insurance is backpedaling on paying

I used to work for a managed care company.  I am not a lawyer, and I
know nothing about your insurer:

1.	Document every call and keep every piece of paper.  Know who what
when where and why.  If you have documented the original call, you're
in better shape now.

2.  They ARE worried about their own liability if they approve an
inappropriate pump, and they probably know little about it, so educate
them with information on young children and pumping.  Especially tell
them - and refer to books - about the fact that it can take six months
to get a basal rate and boluses regulated.  No one does well on the
pump at first.  Where's your doc in helping with this?

3.   Talk to someone at the Federal Employees Benefit Plan management
office.  Know your rights.  Being in that plan gives you lots and lots
of protection.

4.   Personally, I would send them the BG's.  They probably just want
them to cover themselves.  If they are SOOOO terrible, you might
delay, but to protect your rights, you need to comply with the plan's
internal review processes.  They can say we probably would have
approved it, but we didn't get the documentation.  About the promise
made earlier, they would say they thought about it and changed their
minds for medical reasons, and, by then, they would have them.

5.	If any decision goes against you, immediately, in writing by fax
and letter, request an emergency or expedited appeal.  It will go to
higher level MD's.  Copy your Senators and Congressperson.

6.	Ask who's the plan's senior consultant on Diabetes or the medical
director dealing with this case.  Have your MD talk to one of them or
to the plan's medical director.  If they know that a reasonable,
competent doctor, and parents backed up with documentation, are behind
this, they will give in.

7.	Be a demanding parent but not hysterical parent.  Stay professional
but very very firm.  If all else fails call the papers, a lawyer and
the JDF and ADA, but I don't think it will come to that.

Good luck.  In the long run, you can't lose.


Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
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