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[IP] Fighting Insurance Companies

I was denied coverage many times but wanting to convince my HMO that it was
the right thing to do, I persisted for quite some time to educate them on
the value of insulin pumps.  Even though I knew they were required by my
state to provide the coverage.  My doctor met the HMO medical director at a
meeting and asked if he could discuss insulin infusion pumps with him.  The
medical director asked if this was regarding my request and then volunteered
that neither I nor anyone else in his district would ever get a pump.  When
my doctor informed me of this, I immediately called my New York State's
insurance department, consumer affairs bureau, and was told to send them the
letter of denial and I would immediately get my pump with the HMO's
blessings.  I did and they did.  At last count there are 37 states that
mandate coverage for supplies and services for diabetics, and the list is
growing.  As mentioned below, they all refuse whenever they feel they can
get away with it.  The state of Washington (I think this was the state in
question) has mandated coverage since 1997 and it will be worth calling
them.  Some information can be found at the American Diabetes Association's
web site at http://www.diabetes.org/advocacy/statelawmanual/washington.asp

John Kinsley
email @ redacted
Type 1 since 1956
MM 507 since 6/9/98

> >
> >RoseLea and Max... back to fighting the insurance company!
> ......<snip>.........I really get angry knowing there are many people out
> there who get denied from there insurance co. and don't pursue it.
> The insurance co. knows they can't win, but they'll take it as far as
> possible hoping you get weary and go away.  That's what happened with
> us.  We were a thorn in their side.  As I said, we did our homework,
> submitted more info than they needed, and continually got denied,
> went through appeals' process.
> The day before the
> hearing, we got a call saying the pump had been approved!!  They knew
> they were going to lose but wanted to see how serious we were about
> taking it to that far.  Hang in there - we're glad we did - hopefully
> to also help pave the way for others.
> Cindy, mom to 13 y/o Noah, dx 6/96, pumper since 7/99

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