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Re: [IP] Battling the insurance company

Hi Sherry,

I think your best bet is to work with your HR department and try to 
convince them to change the cap on DME supplies.  The insurance plan is put 
together by your HR department, according to what they think their 
employees will need and what the company can afford.  HR staff often think 
that the majority of employees don't need much in the way of DME and so 
they save money by having the cap.  If you explain to them how much this 
will cost you, and how much it will cost anyone else who needs an insulin 
pump, or a CPAP machine, prosthetic, or any other durable medical 
equipment, they may change the policy.

I've talked with insurance companies until I was blue in the face about how 
stupid it is that the tubing and reservoirs are classified as DME and I've 
never made any progress with them.  It's just ridiculous how they can 
classify this stuff as DME while syringes are a prescription item.  The 
reason, as far as I can tell, is that because the pump 
is--correctly--classified as DME and the syringes and reservoirs are needed 
with the pump they get stuck in the same class.


At 10:08 AM 9/25/01 -0500, you wrote:
 >(I hope I'm not sending this twice.  I think this post was lost in space
 >because I  haven't seen it on the last 3 or 4 digests.  If it is a repeat, I
 >apologize. Since writing this I have emailed the problem to the HR head, but
 >she hasn't answered. I doubt she will be much help.)
 >Okay, many of you remember my whining the other day about the cost of my
 >deductible for pump supplies, which my insurance currently classifies as
 >"durable medical". A few people said I should call the insurance company and
 >ask for written proof of why it is classified that way.  I called and the
 >customer service rep. could find no mention of pump supplies or tubing.  She
 >said it was covered as "other" and offered no more help. I then made some
 >calls and found out that the 90 supply day mail order prescription service we
 >have will supply tubing and reservoirs.
 >Doesn't that seem to imply that it should be under prescription services? And
 >Does anyone have any other suggestions on what to do?  Shall I call back and
 >just be very assertive to the customer service reps at the insurance company?
 >Should I write a very formal letter? Should I have my doctor call?
 >What is the most effective way of dealing with the insurance monster when 
 >classify something one way, but have no written proof?
 >Sherry C
 >>From the massive city of Bowling Green, KY
 >Who can't afford $1400 per year deductible plus 20% copay and is somewhat 
 >about dealing with strangers
 >for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
 >send a DONATION http://www.Insulin-Pumpers.org/donate.shtml
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml