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Re: [IP] Insurance Problems
- Subject: Re: [IP] Insurance Problems
- From: "Michael" <email @ redacted>
- Date: Tue, 11 May 1999 14:37:09 -0800
> Our insurance (Tricare/Champus) is still refusing to pay for Kelly's
> pump training/ start-up costs. They say education should come with
> the pump. Disetronic is more than happy to train me on the pump,
> though I believe I have it all figured out by now regardless, but
> the endo and CDE want us to go to the only ADA approved
> pump-start-up treatment center in the area for at least an 8 hour
> initial start up day.
This is the usual crap. Take a close look at the language in your
policy, particularly with respect to durable medical equipment. I
suspect that they are contractually obligated to pay since it is
"medically necessary" in order for you to properly use the pump.
There is a very good chance that you will win this on appeal or if
they force you to challenge them in court. Don't give in. It took
1 1/2 years to get my insurance to pay for Lily's pump, but they
finally did. After all that time, I finally told the Director of the
appeals division that I didn't give a rats a-- what they did, that if
I didn't have the matter resolved in 10 days, they would hear from my
attorney with a copy to the state insurance commissioner. They paid!
and all has been well since. I expect it will be easier for you. Time
has gone by and more and more pumps are in use. The insurance
companies know the ropes now, I think they're just trying to wiggle
out of paying the bill, hoping you will give up.
The other tack to take is to get them to agree to have a pump trainer
come to your residence or the Dr's office for a day of training.
Probably won't take that long anyway. Lily and I spend about and hour
or two with a trainer, read the manual, watched the video, read
"Pumping Insulin" , then went to the Dr's office for a 15 minute
appointment. That was it!! he blessed us and we were off for a piece
of apple pie.
email @ redacted
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