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Re: [IP] RE: Insurance Questions

> Hi guys!!!
> I am trying to get my insurance company to cover my Insulin Pump
> supplies. I am now under Aetna USHC - Ohio.  I have been paying for
> supplies for about 5 years now and over the years, my insurance
> company stated that they were not covered.  How are these supplies
> classified under your insurance plan? Thanks for the help!!!
Home medical supplies.

Check your policy out carefully. Unless these supplies are 
specifically excluded, your insurance carrier is probably required to 
cover them -- might as well file the claim for all year involved.

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 insurance commissioners office or 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 above. 

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

At some point in time after you have been reasonably polite, start the
appeals process. Even if this process is denied, continue at that
point to contact the medical director for the insurance company and
re-start the process. They'll eventually cave in. Keep up the faith, 
attack, attack, attack.....


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