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[IP] Followed Pam Brown's Advice - Filed Grievance w/Kaiser Permanente



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?


Becky LaSpina

Type I since 1957

Animas PING current pump
.
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