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



I think you should keep going up the chain of command.  This is
insane.  Millions of  us use Humalog 100u in a pump.  Would they think
FDA would have gotten wind of this use being illegal?  I just don't
know what the next step is as I am not on Medicare yet.

On Mon, Nov 7, 2016 at 5:14 PM, Becky Michael LaSpina
<email @ redacted> wrote:
> 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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