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Re: [[IP] Re: Insurance Questions -- Michael]

"RoseLea" <email @ redacted> wrote:
> I just got the new book for my Blue Cross Blue Shield of Michigan PPO Plan.

> There are other statements regarding the definition of "Medical Necessity",
> but it does state that "Medical Necessity is determined by physicians
> for Blue Cross Blue Shield.  It is based on criteria and guidelines
> developed for Blue Cross and Blue Shield by physicians acting for their
> respective provider types."  

Treatment of diabetes is any form currently available is necessary. They can
NOT dictate whether you can get a ppump or not, or even if it can be rented.
This is as interpreted by the US Federal government in various cases over the
years. If the pump is not SPECIFICALLY banned in the plan documents it cannot
be denied.

It goes on to say that the covered service must
> be accepted as necessary and appropriate for the patient's condition and
> mainly for the convenience of the patient or physician.
> So.... I take this to mean, that Blue Cross Blue Shield has physicans who
> can make the determination whether the Durable Medical Equipment is
> medically necessary regardless of what my own doctor says.  They claim to
> have guidelines.  Hope that doesn't hurt my chances for approval, which I'm
> still waiting for........

Nope, can't affect your chances at all.

Have you offered to have your state insurance commisioner talk to them about
their lack of needed support for your better health yet?

Ted Quick
email @ redacted 

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