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[IP] RE: Disgusted with insurance companies

email @ redacted said:::

Venting is healthy.......has your doc written a letter of medical necessity?
is the pump company helping? is this written in your contract? have you
notified the state board of insurance?..............just off the top of my

Rosealea asked what the insurance company is...
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My insurance co is MCARE HMO.. and yes I know that is the issue.. HMO's
stink... I guess I am just going to have to deal with it as I cant afford to
start paying out of pocket for a pump especially since my current pump DOES
still work.. (i just wanted the updated technology that my pump does not

To answer Beverly.. YES my doctor went through all the hoops with me.. She did
what she could to convince them.. bottem line my A1C is too good.. My heatlh
is too good..They have their bases covered.. it does state in the contract
that they will only cover a new pump every 5 years, as medically necessary,
etc.. so I cant say they made it up.. Dont know what good the state board
could do.. I think I am just going to have to wait the year and try again when
my pump is 5 years old!


Joni -

I don't have much experience with insurance hassles but you need to convince 
them that you are insuchh good shape because of the way you take care of 
yourself.  Then you need to convince them that it would be cheaper to 
continue with a working therapy (i.e. a fuctional pump) than it would be to 
pay for treating you in a hospital bed.

Additionally, since this company didn't buy your current pump, how can they 
deny you a new one by imposing a 5 year limit on replacement?  Are they 
authorizing payment for the disposables for your pump?  I also wonder if the 
insurance co is aware that no pump company warranties their product for more 
than 4 years?

As for letting the state into the mess, the board does regulate some aspects 
of diabetes care.  If you let the insurer know that you intend to let the 
state board that someone (the insurance co.) might be practicing medicine 
illegally (without a license - unless the refusal is signed by an MD) since 
you and your doctor have complied with all their requests.  It just applies a 
bit of leverage.

I repeat Beverly's question - have you gotten the pump company of your choice 
involved in the process?  Sometimes they know wrinkles to get around 'stupid' 

Above all, even if it takes the full year, be a squeaky wheel and pester the 
insurance people until they cave in.  Sometimes they'll give it up just to 
get you off their phone lines!

I wish you luck in getting you replacement!

  Katherine Nelson & MyHope2 (the pump)
dx T2 '86, T1 '96, 
MM 508 - 5/15/01, MM 511 - 9/13/02
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