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Re: [IP] Need help, i've got the insurance blues...

Our insurance has a $1500 per year cap on "durable medical equipment" -
however, in the state of Connecticut, that cap is waived for diabetes
supplies.  Therefore, our insurance (at the time, we had BC/BS of CT)
paid 100% for the pump and supplies.  Our current insurance (Med Span)
pays for 100% of our supplies, including his test strips which we
purchase from a local pharmacy that has a medical supply business.  His
pump supplies are ordered directly from Minimed and we have never seen a
bill for anything.

The way it was explained to me was that if my son had met the $1500 in
one year for diabetes supplies, they would continue to pay over that
amount because there was no cap on diabetes supplies.  However, if he
needed another item to be covered under "durable medical equipment" for
another condition, it would not be covered because he had gone over the
$1500 limit.

One frustration we did have when he got his pump was that MM obtained
approval from BC/BS for the pump, it was ordered through American Home
Products as dictated by BC/BS in May 1999 and was not paid for by Blue
Cross until October 1999.  Blue Cross had rejected the bill at least
four times for various reasons between May and October.  American Home
told me that they had 24 bills pending payment from BC for pre-approved
pumps.  Seems like insurance companies reject first, ask questions

Check to see if there is this no cap rule for diabetes supplies in your
state, and good luck.  Keep fighting, and don't let the idiots get you

Mom of Steven, 14, a very happy pumper!

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