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Re: [IP] dme batteries

Miller, Miranda wrote:
> I'm not getting my pump supplies or batteries covered under the pharmacy
> plan because they're dme -- go figure.  

In the state of Connecticut, if you have a DME benefit on your
insurance, they have to cover diabetes supplies.  Our current insurance
pays for Steve's supplies at 100% directly from Minimed, batteries
included.  They are ordered as a "Disposable Power Kit" (Model 104) from
MM, 9 batteries and infusion set tubing clamps - IF we order the kit
when we order our other supplies.  While our insurance has a $1500/year
DME cap, diabetes supplies are excluded from the cap under state law. I
called the MM supply line directly when our insurance coverage changed
on September 1, and they called our insurance company to get approval
for the order.  It was all very simple.  The supplies arrived last week,
with a bill for over $600 - now I just have to hope and pray that the
insurance company (MedSpan) pays the bill.  I have copies of their
authorization form in case it is needed.

Of interest - in May when we ordered Steve's pump, we had Bluecare HMO
(Anthem Blue Cross of CT).  MM cleared the pump with them and we
received the pump and supplies (covered 100% under our contract and in
accordance with state law).  Bluecare has STILL not paid for the pump. 
They have paid for supplies (I asked them what we were supposed to do
with infusion sets if they didn't pay for the pump).  They told me "the
computer rejected the claim".  Steve asked if they were going to take
his pump away.  I told them to fix their computer program.  I called the
state insurance commission and have filed a complaint.  Bluecare then
told me that it was "in review". I'm calling them daily.  Even though I
know it is covered, it irritates me that they have not paid for the
pump.  The company that supplied the pump under BC/BC is American Home
Patient.  They have been wonderful to work with.  They told me that they
had 30 claims for pumps that they have submitted to Anthem in CT and
have only received payment for 5 (all of them are pre-approved).  I
think the insurance companies just reject the claims for over a certain
$ amount and wait for people to complain.

Enough said. I'm getting tired of fighting for what is mine, but will
DEFINITELY not give up.

mom of Steven, 13
Pumping (happily) since 7/6/99
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