[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IP] Frustration! Help me (insurance)

> Ok everyone help me out here.  Taylor was diagnosed in March 99. 
> Today we had an endo appointment and asked about the pump.  Taylor's
> endo is more than happy to place him on the pump, very impressed
> about how often he checks his bg, and his first A1C was 5.2 (dx
> 9.4).  He also said he would make a fine individual to place on the
> pump, but (there is always a but) Blue Cross Blue Shield will not
> approve it until he is 12 so he won't even file for it.  I am so
> frustrated!!! Help me know what is the appropriate route to go to
> try and get this changed!!

The first issue is age discrimination. If he were a burn victim, hit 
by a car any other imaginable disease, I'm sure they would treat him 
now. There is no medical protocol that say not to treat kids with 
diabetes unless they are older than 12. Incidentally, my daughter was 
11 and when she got her pump and we have BlueShield.

First, don't take no for an answer. Tell your doc you are prepared to 
fight to the mat and that you want the prescription and letter of 
medical necessity. If he won't cooperate, you will have to get 
another doc. Call MiniMed and Disetronic (as you choose or both) and 
get referrals to docs if you need another. They also have permanent 
staff that helps fight the insurance battle. You will win, just stick 
it out. If you can afford it, buy the pump anyway and then fight. But 
first you need a WRITTEN refusal from the insurance company so you 
can challenge them for a reason. See my earlier post today about 
fighting with the insurance company.


 I do not want to wait until he is 12.  I
> even went so far as to say I would buy it myself, and his endo said
> no that way because of the financial burden.  Help me know what to
> do he wants the pump so bad, and I want him to have it. Holly
email @ redacted
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org