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[IP] Michael, what do I do?
Michael, I have an insurance dilemma I need help with. Seems my insurance
has a limit on how many glucose test strips I can get per month. That limit
for an insulin dependent diabetic is 200. My pharmacy has been giving me
250, but I'm afraid that they may cut me back to 200 since I'm not sure
they're being paid for all of them. My endo tried to call in for 300 strips
per month which started this whole business, the provider called me and said
that my contract would not pay for that many test strips.
I called the insurance company and they told me that according to the
contract with my husband's employer, they will only pay for 200 test strips
per month. They told me it was specified in the contract. I called the
Human Resource person at my husband's employer and she told me that the
contract did not specify any amounts, it just said that Medical Equipment
was covered at 100%.
I called BC/BS back and the lady explained that their Benefit Adminstration
sets maximum amounts to be covered and, even though it's not spelled out in
the contract, that's what's covered and if my husband's employer wanted more
covered they could have added a rider to get more coverage. I asked her if
they were told that, and she said she didn't know, that that was all handled
by the District Sales Department and she didn't know anything about Sales.
I'm not sure anyone was told anything, since I just negotiated a new
contract between my own employer and BC/BS and I was never told that I would
need riders to cover more than the maximum amounts (not specified) in the
contract. And, even though I am insulin dependent and in need of many test
strips, I can't know about all medical equipment to ask if there are limits
on the coverage and how I can get more.
So, here I am, a new pumper, testing 10 times per day, and due to run out of
test strips the last week of the month. So, what choice do I have now, not
test or buy them myself? Do you know if anything I can do to solve this
problem? The lady from BC/BS said they CAN'T give me more than what is
specified in the contract, even though the actual contract does not spell
out a covered amount. Thanks much, Michael. Boy, do I HATE insurance
companies, even more than I HATE sandwiches!
RoseLea and Max... back to fighting the insurance company!
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