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Re: [IP] Advice for taking on the Insurance Company

what insurance do you have???  -Gianna  (i want to avoid it!!  :)

>From: "TRACEY E DUTCHER" <email @ redacted>
>Reply-To: email @ redacted
>To: email @ redacted
>Subject: [IP] Advice for taking on the Insurance Company
>Date: Wed, 28 Jul 1999 14:09:13 -0500
>Hello All. Sorry I haven't posted much, but have been in the middle
>of a career move and haven't had much time to read and keep up on the
>When I got my MiniMed in March, I had to get prior authorization from
>my Insurance provider and had to meet all of their qualifications
>which went off without a hitch. They authorized it and I had my pump
>within two weeks.
>I had a maximum out of pocket expense of $500 total which includes
>all of my prescriptions for testing supplies and insulin that I had
>to pay up front which I did. Now, for the rest of this year I don't
>have to pay anything for pump supplies or testing supplies.
>But now, I'm in a dilemma and need some advice.
>For the last 3 years I've used a OneTouch Profile glucometer for
>testing and daily management, and when I was on Multiple injections
>it was fine and gave me everything I needed. But when I started pump
>therapy I discovered that it really didn't have the things I needed
>for day to day management.
>Not too long after I started pump therapy, MiniMed and Accuchek sent
>me the 'free' Accuchek Complete monitor and I tried it out for a
>couple of weeks and discovered that it was by far a better machine
>for daily management. Not only that, but I discovered that my actual
>readings were roughly 75-80 points lower than the readings I was
>getting on the OneTouch.
>After calling my CDE and my doctor and getting new prescriptions for
>the new strips, when I went to my pharmacy to get them filled they
>came back as 'not authorized' from the Insurance company.
>I called them immediately and asked the Diabetic case manager what
>the deal was. Seems that my insurance company last November signed a
>contract with LifeScan that they would only authorize claims for
>LifeScan meters and supplies. She told me that I hadn't been notified
>because I was already using LifeScan products and they didn't see a
>need to notify me.
>After discussing with her in detail of why I chose the Accuchek
>machine, she went ahead and authorized a 3 month supply and to let
>her know when I need another authorization.
>Well, lord and behold, I call the insurance provider last Friday only
>to find out that she is no longer with the company and get this RN
>that is taking over all of her claims who knows absolutely nothing
>about the diabetes other than what it is. So I go through the whole
>song and dance again and was told she would check into it and get
>back to me.
>Monday morning she calls and informs me that she had done some
>checking and that there was almost a $50 difference for a 30 day
>supply of strips and that they would apply the amount they would pay
>for LifeScan and I would have to pay the $50 difference. After
>talking with her I found it very odd that there was that big a
>difference in the price, so I did some checking myself. I found that
>there is only a $14 difference between LifeScan OneTouch strips and
>Accuchek's new Comfort Curve strips. I also compared the price of
>OneTouch against AccuChek's Advantage strips and found that there
>was only a $2 difference in price.
>Tuesday I called her back and gave her the pricing information that I
>got and was told they would investigate it further.
>Today, she calls and informs me that what they have decided to do is
>authorize a 6 month supply of strips for my AccuChek machine but that
>at the end of the 6 months I will either have to switch back to
>LifeScan or pay the full price for the AccuChek strips.
>I kind of got the feeling that it was their way of just trying to
>blow me off and hopefully keep me quiet for 6 months, but its gotten
>to the point where I'm not going to just accept that and move on.
>In my opinion, they should be thankful that I'm willing to check as
>often as I do and that it shouldn't matter to them what the difference
>is. In the long run, its saving them money. You would think that
>after paying $4500 for my pump, they would want me to use whatever
>resources I possibly could to get the greatest benefits of pump
>therapy. Do you think they would rather I just stop testing all
>together? I don't think so.
>To throw one more worm into the mess, I just recently found out from
>my MiniMed rep that my insurance company is trying to set up a
>contract with MiniMed authorizing only MiniMed pumps for new pumpers.
>So they are going to issue MiniMed's pumps, MiniMed is going to send
>out Accuchek machines, and they aren't going to cover the supplies
>for them.
>I'm in the process of building up a campaign to launch against the
>insurance company and hopefully raise some hell and get something
>changed. I know its a long shot, but I refuse to sit back and let
>them tell me what's better for me, especially when they have people
>making decisions that have no clue about the daily life of a
>diabetic and the things that we must go through.
>I would really be interested in any advice, suggestions, etc from any
>of you on how to move forward with this.
>Please email me directly as it will be easier for me to read your
>Thanks in advance.
>Tracey E Dutcher
>Type I
>Diag. 7/85
>Pumper since 3/24/99
>Insulin Pumpers website http://www.insulin-pumpers.org/
>for mail subscription assistance, contact: HELP@insulin-pumpers.org

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