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Re: [IP] How to get ins. company to decide

Your insurance company is required by law (the ERISA) to respond to 
any pre-service claim in a set amount of time.  I have the 
information about this on my web site (which is down at the moment, 
due to my ISP stinking very much).  But you can also get it from the 
US Department of Labor web site.  I THINK it is 15 days.

My advice is:
1 Do EVERYTHING in writing.  Send letters certified, with return receipt.
2 Write down EVERYTHING that happens.  Whom you spoke to, what was 
said, the date, etc.
3 Always put a deadline for response in your communications.
4 Check with your state insurance regulatory agency to find out if 
your plan is under their jurisdiction.  If so, get them working for 
you right away.

Good Luck!


>Date: Wed, 7 May 2003 02:43:24 -0500
>From: "Kristen Olgren" <email @ redacted>
>Subject: [IP] How to get ins. company to decide
>I'm sure some of you remember that a while ago, I ordered a new insulin pump,
>and that I need to get it before June 1, as my insurance is changing.  The new
>insurance will pay for DME *up to* a $2000 cap.  We are not money bags, around
>here, and I don't have a money tree growing in the back yard, either.  If we
>have to pay $4000, I guess I'll be back on MDI if my 507 dies on me, perish
>the thought.
>That is, if I DON'T get it prior to June 1.  If I get it before then, I pay
>nothing.  A nice little arrangement.  The problem is my insurance company has
>been "reviewing" the request for the new pump for a couple of weeks now, and
>I'm starting to get very antsy.  I'm leaving town in the middle of the month
>and don't want to spend my vacation trying to negotiate with insurance, or the
>headache of having it arrive while out of town.
>Does anybody know anything I can do as a patient to try to hurry them up a
>little bit in issuing a verdict?  I try calling customer service, but the
>person I am speaking to, obviously, isn't reviewing it.  I'd like to rattle
>some cages, but I don't know what cages to rattle.  My doctor's office
>submitted the required paperwork, Logimedix has submitted it for
>precertification, so the only remaining hold up is -- insurance.
>I can't imagine what could take weeks to decide, and it is driving me nuts.
>Not that that's a very long trip.
>dxd 1985, pumping since 1990

"Never offend people with style when you can
offend them with substance." --Sam Brown
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