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RE: [IP] how does your doctor write prescriptions?



Michael, I just spent since Oct 2005 when I got my pump and supplies filing
appeal to HMO Insurance Co then to second level HMO Insurance Co. then to US
Office of Personnel. The holder of the Health contract and still lost. My
complaint was that my Endo prescribed 15 sets and reservoirs for 30 days.
MiniMed packs them in boxes of 10. So 3 months would be 45 units that would
5 boxes. I am being charged 5 co-pays for the 3 months supply. That is
$100.00 instead of $60.00. They came up with "They are covered under DME
Durable Medical Equipment". They said under DME 1 co-pay is required for
each box. I said the booklet I have does not say that and OPM says it does
not matter it is what the HMO has said the benefits are. Now we know that
Durable Medical Equipment is something that can be used more than once.
Medical Supplies are only useable once. My contract booklet list insulin
pumps and Blood Glucose Meters as DME. The booklet also says that Blood
Glucose Strips are Medical Supplies. The booklet has nothing about pump
supplies. The HMO is saying that the sets and reservoirs are covered as
insulin pumps. Go Figure. I sent an appeal to the New York State Insurance
Commission.
They said they have no jurisdiction over the Federal Health Insurance
Program. I am done. Come November I am switching to another Insurance
Company.

John S Wilkinson, 
Rome, New York
 
 


-----Original Message-----
From: email @ redacted
[mailto:email @ redacted] On Behalf Of Michael
Sent: Friday, July 14, 2006 5:01 PM
To: email @ redacted
Subject: RE: [IP] how does your doctor write prescriptions?


> They say I have to pay another co-pay to get the rest of the months 
> insulin. Their reasoning is that the second bottle would be more that 
> 30 days supply. They error on their side not mine.
> 
> John S Wilkinson,
> Rome, New York
> 
> 

Ask them where it says that in your copy of the contract of insurance. 
And.... contact your state insurance comissioners office and file a 
complaint. They are contractually obligated to supply you with the 
medications you need. It's not your fault that your supplier cant' 
break down the insulin bottle into smaller pieces. 

You should use the insurance companies appeal process, appeal a second 
time then file a complaint. You will win this one, they are just 
hassling you.

Michael

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