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[IP] If you have it- USE IT
I/my dad had to do battle with the FEP BC/BS to get them to pay for my
pump. By all means, if you have the pump USE IT!!! You can make them pay.
My little saga with them was I faxed in the paperwork the middle of
January. They said it would take a week. Gave them a week. Then they
said they needed more info... all logs of the past 6 months and then I
would find out in a week. Fine. Gave it to them that day (incidentally
they NEVER called me/Dad, it was all us). I think I was denied at this
point. Which I immediately appealed to a medical review board. By this
time it was the end of February. With my dad's
permission/blessing/finiancal backing, at this point I decided I was going
to get my pump ordered by the end of spring break regardless of BC/BS. I
got my pump April 3rd (three weeks in March were out because of last week
of classes, finals week, and spring break). I was pumping April 6th.
April 28th, I got approved for my pump. Sometime in May, it was reversed
and I was denied. In June I was approved again, then denied. By July, I
was approved and stayed that way until August in which they denied me
again. By early September I've been approved and stayed that way. An
interesting note to all of this is that 1) they haven't seen or requested
any logs after I faxed them the 6 months worth in January and 2)they never
had a problem paying for my supplies for pumping even while they were
arguing it. All I kept saying while I was fighting was at least I had my
pump while I was waging war. Hehehe, a lot easier to manage the stress of
it! My dad "fights a lot of fights" so to speak. He has experience
dealing with this bauracracy. I'm not even sure why I was denied in August
(at the time I wasn't really at anyone place that they could call me so I
had him do it, but since someone said something particularly stupid and
rude to him in Feb regarding the pump, he was willing to help however to
get it approved... for princple alone). He was talking to them on the
phone at work and got so enraged with them, he hung up, walked 2 miles home
to calm down, then called back. And according to him, this time he really
was not "that angry" with them. My mom overheard the "not angry"
converstation, and said if that was "not angry" she would sure hate to see
what angry was and suggested that I not even ask why I was denied so we
wouldn't have to relive it. By the way, yesterday I got the co-pay part of
a bill that BC/BS just paid... guess when the date of the service was...
5/98. Sigh. At that rate, I'm going to not be on their plan for several
years and they will be approving/unapproving my pump. I'm glad I don't
have to wait to get my lab results until after they pay for them.
If you have it, use it! You can fight and win!
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