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[IP] Pump, insurance help (long)

With the number of people on this list, I am hoping someone has some
suggestions to help us get thru what is going on with the endo and

In a nutshell, we have a pump, and can't get trained, unless we can/will pay
$1,620 to the endo for training.
We were approved for the pump, 80/20, ok I can live with that. $1,000+/-
Called ins, "our endo requires a training class for all pump patients, is it
covered?" YES 100%
Finally get the training class scheduled.
Endo sends in pre-approval for the training class. Sorry, ins denies, saying
pump training is included from the pump manufacturers. But wait, the pump
CDE can't train patients of Children's Medical, due to an agreement they
have and Children's will not allow training from the pump rep(CDE). The endo
wrote a letter of medical necessity and still the ins denied it. If the endo
deems this medically necessary and the ONLY way they will support a pump
patient, how can the insurance deny it?

So we have a pump, and unless we want to change endo's or pay for the
training class, we can't use it.
The insurance is Blue Cross Anthem COBRA $875mth with NO handbooks, coverage
information or anything available to state exactly what's covered, irks me
just thinking about it.

We have escalated it within Children's (no cigars) and are waiting to hear
back from the person who denied it at BC before we escalate it there.

Any suggestions would be greatly appreciated.
Mike Swaithes
Dad to Alicia 9 & Lindsey (Z) 12, dx 5/98

(Sorry to those of you who get this on both IP and IPp)
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