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[IP] Another Denial.....Grrrr (kinda long)
I have been trying for almost two months to get everything in order so that I
can get off the rollercoaster and move onto the pump. Unfortunately, my
insurance company doesn't see it that way. After reviewing my records, they
denied the pump on the basis that my last A1c was 6.5 and I've never been
hospitalized for a severe hypoglycemic event. (Here comes the vent) How
ridiculous!!!! OF COURSE ....I have good A1C numbers because I have lows
EVERYDAY.....EVERYDAY I swing between 250 and 30, most times I can be get
below 50 and not even know it. DOn't they know that the A1C is just an
average?? (One time I was feeling a little wierd, tested and was at
19....that's my lowest that I've caught on my meter). I have had nighttime
episodes where I've gone into convulsions and if I didn't have my wife
sleeping next to me, I probably wouldn't be around to talk about it today.
But.......according to them:
"The medical services are not certified because the patient has acheived
excellent control of his diabetes with his current regimen. He is not having
frequent or severe hypoglycemic episodes. For this reason, use of an isulin
pump is not medically necessary"
Where did they come up with that??
The insurance coordinator at MM has been fantastic and I'm sure that she will
help me with the appeal process, but I'd love to hear any suggestions that
you may have or would love to hear how any of you have dealt with convincing
these companies that it really is a matter of life or death.
Btw....my insurance carrier is Great West and until now, I've had no
T1 since 1990 at age 28. MDI, 3 types of insulin, Min. 4/day
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