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Re: [IP] Insurance - got to love them!



At 10:35 PM 5/30/2006, Julie A Blair wrote:
>When insurance companies start impeding on my son's health, it 
>really upsets me....  We have Aetna Insurance and they approved 
>Adam's pump and paid for it.  In January we ordered our first order 
>of supplies and what a time it was.  All of our prescription 
>medicine is ordered through ExpressScripts.  I called them in 
>January to order supplies - the reservoir and quick-set and they 
>told me that they do not carry them and I would have to go through 
>Minimed.  I called Minimed and they shipped me the parts right away, 
>no money was needed on my end for they were going to submit directly 
>to the company.  I later received a denial from Aetna to pay for the 
>parts and when I questioned this with Aetna, they stated I needed to 
>go through ExpressScripts...to make a long story short with this 
>situation, nothing was resolved and I still owe Minimed over $500 
>and they haven't billed me yet (of course I am fighting this with my 
>insurance company - why would they approve the pump, but not the 
>parts).  About a month ago, again I sent the prescription to 
>ExpressScripts and after 10 or more days was told that they could 
>not send the reservoir and quickset, I had to go through MiniMed. 
>Well... guess what, the two parts I had remaining failed and tonight 
>I sit here with no quickset to insert into my son in order to 
>provide him with insulin, all because no one knows who is on 
>first...!!!  I did call Minimed and they are going to ship to me 
>next day upon Aetna approval, what this means I don't know.... I 
>need to call Aetna tomorrow... IN the meantime, Adam's doctor stated 
>he will need to have a corrective shot every four hours 
>(ouch...).  What a mess, insurance companies, don't you love 
>them!!!!!!!  If I carried $500 in my checkbook every month I would 
>pay for this expense myself and forget about insurance!

My sister went through this with her insurance.  They paid for an 
Animas pump for her but the supplier she had to go through didn't 
carry Animas cartridges.  She contacted her insurance company, HAP, 
and they finally gave her special approval to get her cartridges from 
Animas.  I believe she had to have the supplier tell HAP that they 
did could not supply the cartridges.

So, I would tell ExpressScripts to tell Aetna they cannot supply the 
MiniMed reservoirs or QuickSets for your son's pump.  Doesn't your 
doctor's office have some supplies on hand for these types of 
emergencies?  I know that mine does.

RoseLea
.
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