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Re: [IP] Need Help with Stupid Doctor!!!
- Subject: Re: [IP] Need Help with Stupid Doctor!!!
- From: "Michael" <email @ redacted>
- Date: Wed, 12 May 1999 14:53:48 -0800
> << There is at least
> one list member who has experienced this problem, I don't know if
> the member is still with us. It is the only instance I know of
> where the denial of benefits was not overturned. >>
> I'm one of the members who had this problem. My husband's
> union gave us an outright "NO", but after LOTS of letters and
> pestering it was possible to get the pump covered for Steven. We
> had to send LOTS of proof of how bad things were on MDI and several
> A1c's, etc. As many people on the list advised us perseverence paid
> off in the long run. We ended up getting the pump covered at 100%
> and supplies at 100% too. They have a general clause that they
> tried to use on us saying that they could exclude coverage for items
> not specifically mentioned in the benefits booklet, but we ended up
> being the first and only ones so far to be approved for the pump.
> They do it on a case by case basis from what I understand. The one
> thing we learned throught this battle was that the Department of
> Labor is the "governing" or "overseer" of these types of Union
> Benefits Plans so if you're having a problem that is the place to
> turn for help.
This is excellent news. Now, as far as I know, 100% of insurance
battles have been won!!! Good work. Perhaps you would document what
you did in a little more detail and post it. I know the union
contracts are quite different from a standard insurance contract. The
hoops you jumped through things you did to convince the powers that
be to pay would be useful information for the next "victim".
email @ redacted
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