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



 I I have been using Nova log for years in my pump. I B have been on a pump
since 1999. i found it was more heat tolerant than Humalog. i had at 1 point had
to get my endo to write a letter of medical necesity.


Sent from my Galaxy TabB. E
 -------- Original message --------From: Shannon Couhig
<email @ redacted> Date: 11/7/16 8:46 PM (GMT-05:00)
To: email @ redacted Subject: Re: [IP] Followed Pam Brown's Advice - Filed
Grievance w/Kaiser
B B  Permanente 
 What about Novolog? It's the same exact recipe as Humalogb& But, my insurance
company vacillates between the two. They're always going back-and-forth. It's
whoever has the contract most of the timeb&

Sent from my iPhone 

 > On Nov 7, 2016, at 4:14 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
> .
> Follow us at https://www.twitter.com/insulinpumpers
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Follow us at https://www.twitter.com/insulinpumpers
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