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Re: [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
> insurance.
> 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.

1) Your employer is required to provide you with a copy of the 
contract of insurance if you ask for it.
2) definetly escalate it at the insurance company NOW. There is 
usually a two tiered appeal process, the first one usually fails and 
the second does not (most people give up after the first try). Start 
the appeal process now so you don't have to wait so long to get the 
second phase going. The THIRD phase is with the state insurance 
commisioners office and they will require the other two to be 
complete first.
3) what state are you in.... does the state mandate coverage of 
diabetes training? --- many do.

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