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Re: [IP] Convincing Blue Shield...

wombn wrote:

<<They rejected the humalog pen just last week, telling me that it
> wasn't a "medical necessity" and that they cover syringes.  Well,
> the only time I got a syringe prescription (March), they rejected it
> and I had to pay full price.  So either someone's confused, lying,
> incompetent.... or they've changed policies recently.>>

OK, I want to say a little bit here about insurance.  The main thing with
most insurances is you got to learn how to play their game.  I have Blue
Cross/Blue Shield of Michigan, and to give an example here:  My endo
prescribed Ketostix ketone test strips when I went on the pump.  Now, I need
a dr's prescription and letter of medical necessity for these types of
supplies (as well as glucose test strips) in order for it to be covered
under my "medical supplies" coverage.  These are non-perscription items for
me.  My pharmacy by mistake sent it through prescription coverage rather
than medical supplies and Blue Cross rejected and said it wasn't a covered
benefit.  No, it wasn't a covered benefit under prescriptions.  They
resubmitted the claim under medical supplies and it was paid with no
problem.  My point here, is that you need to make sure that the information
is being sent to the right department at your insurance company.  Some of
the large companies will just dismiss a claim even if it is just sent to the
wrong department (wrong mail drop in the company).  It's up to you to make
sure where the claim needs to be sent.  Call your insurance help line and
ask them where a claim for medical supplies such as syringes needs to be
sent.  If it's not a prescription covered item and the pharmacy sends it in
as a prescription, it will be rejected.  Sorry, didn't mean to be so long
here, but you need to know how your insurance works so you don't have these
hassles all the time.

As far as covering my pump, my insurance paid immediately with no questions
as soon as they got the claim submitted properly.


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