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Re: [IP] Insurance Problems

> 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.
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