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Re: [IP] insurance woes

> We are having some problems with my parents insurance wanting to pay
> for my pump supplies.  It is through my dad, and it is a carpenters
> local union insurance.  I have not had to order any supplies since
> we started using this insurance until now, and they will not cover
> the supplies bc they are mail order.  They said that they do not
> deal with mail order.  My step mom has written the board of
> directors of the insurance, and we are still waiting to hear from
> them.  Mini med sent me a few samples, but I just used my last ones
> yesterday.  Does anyone know of anything else we can do, and is
> there anyone who would be willing to let me purchase a few
> reservoirs and minimed sof-set ultimates until we hear something?  I
> am in Rome Ga.  Thanks in advance, Heidi

Hi Heidi,

Most insurance policys are written in a manner that says all normal
medical expenses are covered unless experimental or specifically
excluded. Since you are unable to negotiate the terms of the policy
and must accept what they provide for policy language, the courts have
taken a strict interpretation of the language to mean that if the
insurance company forgot to mention something, they are obligated to
provide it. Bottom line, pumps and supplies are covered unless there
is specific language to the contrary. You may have to appeal, you may
have to involve the state department of labor in the case of a union 
sponsored medical plan, but DON'T give up, don't take no for an 
answer. If prescription diabetes supplies of any kind are covered, 
then all the pump supplies are probably covered as well as described 

There must be specific policy language written in your policy as the
basis for denial. Insulin Pumps and their supplies are conventional
therapy for diabetes that can be prescribed by any physician.

All that should be required for coverage is a prescription from your
physician and a letter of medical necessity The insurance company can
not contravene a doctors orders for treatment unless those orders are
patently unreasonable and inappropriate.

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