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[IP] Re: BC/BS of Mass. Pump Policy

Dear Sherry,

I read your vehement defense of BC/BS of Mass.'s pump policy, and I
don't think Michael was out of order at all in criticizing the criteria
they use for excluding candidates for pump coverage.  Moreover, if you
think Blue Cross is posting this info on the Net for charitable reasons,
think again.  I've had their coverage for many years, and I've always
found them less than sympathetic to patients' problems and their
difficulty in obtaining proper coverage.

In my own case, when I started on a pump 2 years ago, they covered a
large percentage of the pump cost (I think 60%), but I was still left
with a big bill.  Much worse, though, was their adamant refusal to pay
for pump supplies - reservoirs and tubing, on the grounds that it was
not on their list of approvable items!  I filed a request for review
with BC/BS, on grounds that without the supplies the pump was unusable,
and was still turned down.

I finally had to file a complaint with the Mass. Dep't of Insurance. 
Once they took up my case and asked BC/BS to explain their illogical
policy, BC/BS rather quickly did an aboutface, and I've had coverage
ever since.

Michael is right when he says their current criteria for pump approval
still reflect
a stone-age mentality.  In addition to Michael's points, BC/BS of MA
doesn't cover pumps for Type II diabetics on insulin, despite the fact
that endos are increasingly prescribing insulin therapy for Type II's,
and a growing number are now wearing pumps. 
Type II Diabetes has recently been singled out as a serious cause of
heart disease in the U.S., when not properly controlled.  I'm sure that
many would achieve better blood sugar control if they had pumps, but
only those whose insurance offers coverage can afford them.

Lee Lockwood

>>From: Sherry Webb Nolan <email @ redacted>
>>Subject: [IP] Re: BCBS of MA (To Michael)

> I read through the so-called policy statement and it is full of
> about who is suitable for pump therapy. I particularly like the one
> QUOTE - not suitable
>      Patients who have a tendency for hypoglycemia, or who are
>      to detect hypoglycemia, since pump therapy increases risk for
>      hypoglycemic events, 
> and the one about pregnancy
>      Patients who attempting to conceive, or are pregnant.......
>      .......increased risk for miscarriage.
> Gee, talk about stone age mentality, what have they been smoking??
> Michael
> email @ redacted

My main reason for posting this was to point out that BCBS of MA
does cover pumps, and that actually as stated before will evaluate
each case and usually will approve if the doctor has written a letter
of medical necessity.  The big point I was trying to make was that
the site mentions what it will cover if you are approved, such as
various pump supplies.  Listing the site for BCBS of CO was to 
help the person asking for info. find more info. and numbers to
call to get information.

>>As for stone age mentality I think you need to check your attitude.
The fact that this insurance company even recognizes that pumps 
are out there and are willing to cover them seems pretty advanced
to me.  

>>You forgot to mention that they also give links to information sites
for people to find out more about diabetes, such as the ADA, JDF,

>>And find out if there are "myths" on the site.  They are just being
an insurance company and covering themselves by posting this.
Each person who requests them is looked at separately, I personally
know a Type II who was pregnant who got one from BCBS of MA.
So before you make a judgement on my insurance and their policy on
pumps...does your insurance even have one?

>>A bit myphed by your attitude,
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