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[IP] Re: insulin-pumpers-digest V3 #609

Hi. This is in  response to the messages regarding fighting HMOs to get a 
pump and the cost of dialysis.  I am a renal social worker in Illinois and 
would be happy to get the costs for you.  In this state, you will NOT be 
automatically transferred to Medicaid (public aid), but your private 
insurance MUST pay for 30 months (or 33 months, depending how you want to 
look at it) at either 80% or 100% depending on the policy.  After those 30 
months, Medicare will become the primary payer at 80% and your private 
insurance will cover the remaining 20% for as long as you have the private 
insurance.  It certainly adds up for the insurance companies.  And don't 
forget all the special medications you will be on when you're on dialysis 
that your private insurance will have to pay for since Medicare doesn't cover 

I, too, have had my battles with HMOs trying to get a pump.  I haven't been 
successful so far, but continue to re-evaluate whether or not I want not only 
the pump, but the fight that must ensue before I can get one!  (Basically, I 
will have to be a blind amputee who is continually hospitalized with DKA.  
Let's hope it doesn't come to that.)  My doctor also doesn't seem interested 
in getting me on a pump.  As she says, "I've never had anyone ask to be on 
the pump before. Most people would rather have the freedom that comes with 
shots rather than being attached to a machine all the time."  

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