[IP] Followed Pam Brown's Advice - Filed Grievance w/Kaiser Permanente
- To: insulin-pumpers <email @ redacted>
- Subject: [IP] Followed Pam Brown's Advice - Filed Grievance w/Kaiser Permanente
- From: Becky Michael LaSpina <email @ redacted>
- Date: Mon, 7 Nov 2016 22:14:34 +0000
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DENIED once again to have my insulin used in an insulin pump billed to
Medicare Part B.
This time Kaiser Permanente says:" Why did we deny your request? We denied
this request under Medicare Part D because: After careful review it was
determined your Humalog 100 unit/ml solution prescription is appropriately
being billed towards Part D benefits. Your Humalog 100 unit/ml solution
prescription is not consider a conditional B vs D medication, its covered
through Part D as a tier 3 (preferred brand) and is applied to members total
drug cost. HUMALOG DOES NOT HAVE THE FDA APPROVAL TO BE USED IN A PUMP
THEREFORE IT CANNOT BE COVERED UNDER PART B."
I have the right to appeal. Medicare rulings state Insulin used in an insulin
pump. Medicare does not specify FDA approved insulin for an insulin pump.
Opinions please. Shall I give up OR keep making attempts to get KP to
correctly bill to Medicare Part B?
Type I since 1957
Animas PING current pump
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