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Re: [IP] Good new/Bad news?

> Hi:
> Insurance is still draggin their feet authorizing the pump.  I call
> every other day to bug them.  Today I had some interesting news.  I
> had my blood draw yesterday (didn't pass out for the first time in
> 10 draws!) and my hA1c came back 6.1  That is the best one I've had
> in 20 years.  (Unfortunately probably due to hypos too many times,
> my log wouldn't show you great control!)  Anyway, now I'm worried
> that this will be the excuse insurance needs to deny the pump.  I
> just cannot believe 6.1.....I only starteDana

it is not uncommon for insurance companies to try to distract your 
attention from their obligation to provide coverage by raising 
irrelavant issues about hba1c's, control, etc...

You must return their focus to the CONTRACT that they have with you. 
Specifically, unless the contract has language that excludes insulin 
pumps or specifically lays out criteria for denial of coverage, the 
insurance company is obligated to provide coverage for ALL ordinary 
and necessary medical procedures, equipment, etc.... Should they 
attempt to deny coverage, appeal, and ask for a written letter of 
denial which specifically cites the section of the policy that allows 
the denial. Make them quote the language in the CONTRACT of 
INSURANCE. they won't be able to do this and will give you a thousand 
excuses and reasons why they should not have to, but press on :-)

What IS required is a letter of medical necessity from your child's 
physician stating that the pump is a prescribed and necessary piece 
of medical equipment for her care. An insulin pump is ordinary now. 
It is even covered by medicare. In addition, many states mandate 
coverage of all diabetes supplies. Check the LINKS page of the web 
site under INSURANCE to see if your state is one of those that 
mandates coverage -- almost all now have such laws.

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