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Re: [IP] Just venting too!

In a message dated 3/27/99 12:13:20 AM Eastern Standard Time,
email @ redacted writes:

<< > I know what you are saying!!!!!!! ....6 injections a day should take care
 my diabetes
 It really is ridiculous the mindset insurance has about treating diabetes!!
 They would rather pay  an astronomical amount of money to treat complications
 than to help people avoid them or slow them down!  I'm also going to continue
 to fight for  a pump and I will keep you in mind too.  thanks for letting me
 vent. I hope things will work out for you. I think that no matter what kind
 diabetes one has ,everyone deserves the best care possible.  I think it's
 terrible we all have to fight so hard to get what we need.  >>

	I'm sorry to hear what your insurance is putting you through.  Diabetes is
tough enough without some ignorant insurance exec. telling you what you don't
need.  We are in a similar situation with my son right now.  Yesterday I
thought I was at rock bottom, but I know for his sake I have to step up the
fight and make sure he gets a pump.  Steven is 8 and has severe asthma along
with his diabetes.  He takes 3 asthma meds per day along with 4 shots.  Due to
his meds (sometimes on prednisone) and wheezing, he frequently has wild BG
swings and develops ketones very frequently and easily.  We are only at this
"fighting with insurance" stuff for a month now and my nerves are running raw.
I have 3 diabetic children out of 4 and I'm a type 2, both my son and I have
severe asthma and now the insurance is trying to tell me that I should have no
problem with giving 6 or more shots to my 8 year old on a daily basis!  What
kind of a life is that for him?  We had an incident two weeks ago when he had
a severe asthma attack where his blood sugars ran in the 400's-500's (many of
them off the meter---over 600!) with moderate to large ketones.  This happened
for 3 days straight!  Our endo had us beeping him every 3 hours to try and
keep him out of the hospital.  He got shots every 3 hours for those 3 days,
plus nebulizer treatments every 3 hours and they feel that there is no problem
with an 8 year old living this way!!  I'd love to see them change their tune
if it was THEIR child!!!!  Our case is due to be reviewed in April and I've
been told that not to expect an answer till May or June......

	I know many of you have fought the battle and I'm inspired by your
determination.  I know Steven deserves better and I'm willing to do whatever
it takes to get it for him, but it's discouraging.  I feel for all of you who
have fought the battle or are still fighting.  It's a shame to think that so
many insurance companies are "penny wise and pound foolish" when it comes to
diabetes care.  

	And finally, I have a question for Michael:
<<Unless the policy specifically excludes pumps, you have a right to standard
modern treatment.>>

Our policy does not specifically exclude pumps.  I just got the new booklet
yesterday and I have read it cover to cover....NO WHERE does it say ANYTHING
about and insulin pump....the only thing I can find is a paragraph under
exclusions which says:

"Any exclusions under this section will not apply to the extent that coverage
is specifically provided in this document or to the extent that coverage for
charges is required under any law.  Excluded charges will not be used when
determining reimbursement.  The above list of exclusions is provided for
illustrative purposes and is not all inclusive."

Do you think I have a leg to stand on here?  What kind of an attorney would
take on our type of case do you think?  I have a feeling I'm going to have to
find a lawyer to help here.  Since our union is "self-insured" I cannot get
help from the State Insurance Commissioner, but I was told to contact the
Dept. of Labor which I did and will hear from on Monday.  If anyone out there
has any ideas, I would sincerely welcome them.  I thank you all for the
support of this list and the forum to "Vent as necessary"....I needed to do
that today for sure!

Kelly Marshall

Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org