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Re: [IP] insulin dosges (was cold season)

    The insurance co has a formula for what you should need.  This is done based
only on superficial info in their data base.  In fact, a signal will come up in
the computer there when you exceed the set formula.  At some companies (smaller
ones), someone actually goes through and acts on those signals.  At larger
companies, the Rx is automatically blocked next time the pharmacy tries to fill
it.   In either case it is done mechanically, so its not about you. The pharmacist
on the phone is just caring out company policy.  She obviously knows nothing
specific about what you actually need.  Your doctor will have to put in for
special authorization.  This can easily take a while and might get messed up.
    In the meantime, you should also write a letter to the insurance co (you'll
need to find out where to send a letter for "emergency" help.  If they send you a
form, fill out the form and enclose the letter too. The letter should make clear
in no uncertain terms what you need, why you need it and this is a
"life-threatening" (that's the code word) situation.  IT should also be polite.
If you haven't received in answer within one work week call member services and
keep asking for a surpervisor and/or the the person reviewing petitions.  Stick to
your story about this being an "emergency".  In other words, don't say things like
"I still have enough for another two weeks but I really need this..."  Ask each
person you speak to their name and their extension or direct phone #.  After 2 or
3 calls you will start to notice that the explanations vary.  Don't get mad at the
lower level people (they just get unhelpful), but point out your confusion (since
you've now been given a variety of answers and your doctor prescribed this for
you)and ask for a higher up.  Make sure you find out who will be responsible next
time if it doesn't go through.  Get a name and phone#.  If you get a letter in the
mail (or authorization form), call the # and ask for someone who can help you
guarantee this won't happen again next time with a procedure.

    As for the policy premiums, insurance premiums went up almost across the board
this year b/c the companies mostly lost $ last year.  However, if you are insured
through a small group policy, you (or another or more than one) member of the
group with "high risk" (read expensive) medical needs will often cause policy
premiums to go up.  They tend to continue to rise for several years in a row.  If
you are individually insured (through something like a family plan) or self
employed, they may be raising your premiums b/c once they cover you they cannot
drop you even if you prove expensive.  This is a difficult problem since if you
give up this coverage, as expensive as it is, you may not find independant
coverage that will accept you again.  There is high risk coverage but it doesn't
pay for much and is expensive.

Hope this helps a little bit.
The big suggestion that seems to solve the most problems is:  document everything
and let them know you are keeping track and make clear this is life threatening
and that you will act in response to their lack of action.

I hope things improve soon!


email @ redacted wrote:

> Dear Sara,
> You probably will not believe this -- I didn'nt at first.  I received a letter
> from my insurance company (they should all roast in hell) that according to
> some vague criteria I was using TOO MUCH INSULIN!!!. -- or more than the
> average diabetic.  The result of this would be that I would receive less
> insulin per prescription!
> When I called the company a pharmacist called back and said that they were
> doing this for my own good to prevent hypoglycemia and to make sure that I
> visited my doctor regurlarly.  She assured me that I would get all the insulin
> that I needed (???) but that my doctor would have to justify it.
> My husband thinks that I am paranoid (just because I'm paranoid doesn't mean
> they're not out to get me) but the only reason I could think of for them doing
> this is that they think I am actually taking less insulin and selling (or
> giving it away) to diabetics who don't have insusrance.  By the way m-- they
> just raised our premiums 25%.
> What do you think?
> Harriet
> ----------------------------------------------------------
> Insulin-Pumpers website http://www.insulin-pumpers.org/

Insulin-Pumpers website http://www.insulin-pumpers.org/