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[IP] RE: insulin-pumpers-digest V7 #408

Date: Tue, 22 Jul 2003 09:26:17 -0800
From: "Michael" <email @ redacted>
Subject: Re: [IP] approval for pump by insurance co.
Thanks, Michael for the good advice and tips.  It's information such as
yours and others that will help me.

Becky - looking to go on the pump.

> What general qualifications does one have to get in order to be
> approved for the pump by the insurance company?  I realize that each
> insurance company is different, but  is it a long drawn out process?
> Thanks,
>         -Becky - looking to going on the pump 
>          email @ redacted

The qualifications are the same everywhere in the US

You need

1)  a letter of medical necessity from your doctor and 
2) a prescription for a pump.

There are some enlightened insurance companies out there that will 
provide a pump solely based on the above criteria. However, many of 
the insurance companies would like you to think otherwise by asking 
for recent hbA1'c, etc... etc....

but... unless the "written contract of insurance" spells out some 
requirement of this kind is is spurious bull s--t to help them avoid 
paying for coverage they are obligated to provide. It has been my 
experience over the years, both personally and through members of the 
list, that insurance companies will attempt to divert attention away 
from the contract of insurance toward "internal policies", or to draw 
you into an argument that has nothing whatever to do with their 
obligation to provide coverage that is deemed medically necessary by 
your physician and that is covered in the "written contract of 
insurance". This is a method of cost control and is done solely to 
save them short term dollars at your expense. If I seem a little hard 
on the insurance companies you read me correctly. I've spend 
countless hours on the phone with these turkeys fighting to get what 
I pay for for my family and I'm perfectly willing to pass on what 
I've learned including all the tricks they use against us in an 
attempt to save a short term buck.  The irony is that studies show 
that pumpers cost the insurance company HALF of what a non-pumper 
costs the insurance company over the long term. You'd think they 
would wise up.

So.... if they give you a hard time, speak up. Both here and to them. 
We'll all contribute what we know about how to get around their 
roadblocks, and you'll get your pump, supplies, or whatever it is 
they give you a hard time about.

..... grrrr..... feeling annoyed today....
email @ redacted
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