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[IP] Re: insulin-pumpers-digest V7 #392

>Advanced PCS person warned me that Advanced PCS is advocating with the
>policyholders to discontinue covering long acting insulins with
>diabetics that are on insulin pumps. She said that Humalog and Novalog
>will only be covered. Personally I use U500 Regular in my pump and told
>her so. She said that I might need to purchase it out of benefits. How
>can they start doing this? There are many still using regular and
>regular is very helpful when you can't or not wearing your pump. I also
>thought that Humalog doesn't have FDA approval for pump use but Novalog
>did or is it the other way around?
>Has any one else heard of RX companies doing this?
>Gail DOnohue

Oh yes!
My ignorant insurance company is doing that and more.  Mine is trying to cap 
the amount supplies to 5 boxes of infusion sets in 3 mos (well some of the 
times thats enough but when I go into a period where I have to change my 
site every 1-2 days, I find I can run short in a hurry since there is only 
10 sets in a box).
My insurance also limits the amount of test strips to 150 per month because 
they say the FDA stats say that diabetics should only test their blood 3-4 
times per day.  They also insist in the fact that all the "normal" diabetics 
covered through this insurance co admit to only testing 2-3 times per day at 
best.  Then they tried to tell me that no diabetic would submit themselves 
to testing 10+ times each day.  When I tried to explain to them why I tested 
so often thus needing at least 300 but more like 320 per month they acted as 
if I was visiting from Pluto. My Endo even tried to explain, so much so that 
he got frustrated and told them that I tested 20 times per day hoping to get 
them to commit at least to the 10.  In fact, I even found myself having to 
explain type 1 diabetes, the pump and the reasons for BG testing to the 
Medical Director of this insurance co (you know, the guy who okays or denies 
coverage for meds, prcedures and supplies) because he didn't understand the 
difference between type 1 & 2 or for that matter, diabetes in general, so of 
course he had no clue about the concept of pumping or BG testing.  This 
idiot had the kahonies to tell me I didn't need a pump since pumps were 
unreliable and no good, if they were worth their salt, then they would 
maintain a perfect BG of 120 all the time but, since they don't they must 
not be able to do the job they are intended to do.
I just want to know what kind of schooling, training or experience you need 
to run an insurance company.  OOPS sorry for the sarcastic and retorical 
question, I guess we all know the real answer hehehe.

dx 1981, pumping 7/2000

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