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Re: [IP] Insurance is backpedaling on paying


That's the best "plan of action" I've seen written down.

This is an ideal document for presentation on the Insulin Pumpers web site.
Would you be interested in having it presented as a "How To" document? If
you're uncomfortable with your name being on it, it can be presented
"anonymously". If you'd like to prepare it yourself, one of us on the
IP-Dev list can help you with it.


Bob Burnett

mailto:email @ redacted

>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.

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