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

> 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. 

Very interesting tactic. Only problem is it's illegal. They can't
override your doctors explicit instructions as given on a prescription
that specifically says NO SUBSTITUTES. If they do so they are 
practicing medicine without an MD license.

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.

Price has nothing to do with it. It's a medical decision whihc was 
already made by your doctor for your better care. It's time to call
the insurance company and get the name and direct phone number for their
Medical Director and call it. Explain the realities off your diabetic 
treatment needs and make it very plain that the next phone call will 
be to the state Insurance Commisioner! Trust you've taken names and 
notes of all calls in the matter, it may lend weight to what you say.
> 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.

You have it right. Insurance clerks always think they can pass
judgement on what we can use, but they have NO right to force you
this way. Time to straighten them out.
Ted Quick
email @ redacted
Insulin Pumpers website http://www.insulin-pumpers.org/
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