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Re: [IP] Personal Choice/Blue Cross & Pump Approval

-----Original Message-----
From: trifona <email @ redacted>
To: email @ redacted <email @ redacted>
Date: Saturday, November 28, 1998 10:48 AM
Subject: [IP] Personal Choice/Blue Cross & Pump Approval

>I am currently waiting for my above mentioned insurance company to
>approve me for the pump.  Although I am a prime candidate for pump
>therapy based on a number of reasons, my Rep. tells me that simply
>because my last A1C was 5.6 and thus below their 7.0 threshold, i will
>most certainly be automatically denied on the first go round and thus
>will have to appeal the initial decision.
>In order to prevent that scenario from happening and thus delay my pump
>treatment i wrote a VERY descriptive letter filled with consequences
>(both medical and otherwise) of not going on my treatment of choice
>ASAP.  So has anyone had to deal with the above mentioned company under
>those conditions?  I'd love to hear how they explained for having that
>ridiculous threshold.

Your rep needs to know about getting a letter of medical necessity from your
endocrinologist.  This will contain descriptions of the hypo episodes you
likely have endured to achieve that 5.6%.

My insurance co. also wanted my blood test records.  These showed the
balance of highs and lows that I went through to get a1cs of about 6%.

Don't give up.  Call every day.  Having the pump gives me a sense of freedom
and control I can never achieve with MDIs.

email @ redacted

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