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Re: [IP] Pump up the volume in U.S. House

Well Anika I have one question WHAT KIND OF INSUR. DO YOU HAVE!!  I only
seen my doctor once which was the first time ever and I just ask him what it
would take to get the pump he gave me the info, ask me to read it , left the
room me and my husband read it then he came back answered any questions we
had ask us wheather we would like it or not and we said of course and from
then on it took about 31/2 wks to get it .. Yes I did have to send a 3mth
list of bgs and my doctor had to do blood work to verify I needed it but
usually the insurance wants you to get it because it comes out to be more
cost effective for them I mean you don't have the hospital bills and other
cost like 2 different kinds of insulin . I don't know really what else to
say except your insur. is jerking you around and you don't have to put up
with that especially since your doctor recommends you getting the pump...
well good luck  if you have any question I will do my best to answer. lisa
-----Original Message-----
From: Anika Schon <email @ redacted>
To: Insulin-Pumpers <email @ redacted>
Date: Thursday, July 15, 1999 10:50 PM
Subject: [IP] Pump up the volume in U.S. House

Three weeks ago, my Endoís order for a pump went to my HMO. I have called
them daily since July 7.  I  faxed them 40 pages of  BGs, hospital records
and articles about the DCCT and the pump. My PCP  faxed them another 34.
    Then yesterday, the HMO person said "It appears the  pump is mostly a
convenience. It even says that in one of the articles you sent."  I blew up.
   I barely regained enough calm to agree to her request for documentation
of my complications (counted in the 40 pages).
    I felt so  frustrated over my inability to communicate to them the
importance the pump for my life and body wholeness. Then last night, I saw
Michael's post.

  >>make sure they have a "letter of medical necessity" from your
doctor. ...(snipped, for economy)  Once that is done, they are contractually
obligated to provide treatment per the doctors orders. At that point you can
stop being polite and begin the appeals process along with a call to the
medical directors office. If they delay or hassle you, it is time to contact
the insurance commissioners office in your state. Do the steps in the order
above, be nice (at first), but be firm and don't take any c**p.>>

Well, by this morning, I had had an epiphany. The truth behind what Michael
is saying and the absurdity of me providing them more documentation suddenly
dawned. If I send this information, Iím unwittingly deputizing them as my
doctors, conceding their ability to decide on my treatment despite lacking
the specialized medical knowledge and  any knowledge of me or my history.
    The information Iíve given, theyíve  dredged for ordnance they can use
to torpedo my case.
  How absurd. If  a doctor needs only charts, hospital receipts and general
articles to diagnose and treat a person, why do I go to their offices month
after month? And why does the HMO have these doctors on their list of
in-network providers if they doubt their competency to determine medical
   (Sigh, Yes, I know. This may sound OK in theory but many have had success
pounding the insurer with documentation.)
   So I called the HMO again. The person I've been hounding wasn't in.
    Then I called my U.S. Congresswoman, (and as a serendipitous aside, the
congressional aide I was talking to told me he himself  has type 1 diabetes
for the last 14 years , tried to get on the pump but so far, he's been
blocked by his now former HMO).
   A congressional staff person called my HMO and urged that they give me an
answer Friday, today. . The aide asked me to call the congresswoman and let
them know how it goes. :^) This may not end the struggle, but that's OK. I'm
prepared to fight on.

   PLEASE READ THE FOLLOWING: I don't blame you if you skipped my above
ramblings but here's the meat. The aide asked if I would write up my "HMO
Horror story" and e-mail it to the congresswoman because the Senate's HMO
patients rights bill has been passed -- or mangled and passed (depending on
your perspective ;^)  it will be going to the House and she wants these
stories as ammo.
    Inspired by the excellent suggestion of George Lovelace and Brian Carter
that we cosign or write a letter to the editor,  I suggest that those who
have had trouble with their HMO might want to write their U.S. House member
now with their views or experiences. This is a consciousness-raising
opportunity and a chance to add a few drops to a legislators (less than
full) bucket o' knowledge  in time to possible do some good. You can find
your representatives web page and/or e-mail address at www.house.gov
   All but ten Reps appear to have  Web sites so you might not even have to
lick any glue.


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Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org