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Re: [IP] Sorta OT but kinda relevant
> You mean there's a chance your insurance co won't approve you for the
PUMP or just the education along with the pump? . . .
> Good luck. Tammy
Yes my insurance company can deny me for the pump. And from what I have
heard most any insurance company can deny a pump to a diabetic. The reason
is that insurance companies have a clause that allows them to review the
need for whatever the doctor is requesting for a patient. Medically
necessary and appropriate and not just for the convenience of the patient or
doctor is how it is usually worded.
It is a way of denying expensive stuff or at the least delaying it in
hopes a patient will give up and go for something cheaper or nothing at all
and just drop dead. If the patient drops dead then the insurance company
saves money because they don't have to pay anything out. Insurance companies
make money from the premiums paid in by healthy people who don't use or
rarely use the services.
Where I work our company premiums went up by over one million dollars
this year because of the amount the employees were using the insurance. Our
POS insurance was fully paid by the company before that. Now there is a
monthly fee if an employee wants the POS. We got an HMO that is paid for by
the company now. I reviewed both policies in depth and found the HMO was
actually better for my needs--cheaper co-pay, my doctor part of the network,
durable medical equipment and supplies covered 100%. Some people opted for
the POS to keep their existing doctor. I was lucky.
I have gone from Humulin R & NPH to Lantus/Novolog MDI. There is a
chance that if I get good control with the MDI (The proof will be in the A1c
dropping) I will not get the pump because I have adequate control with a
cheaper more conventional therapy. I have much better control in the last
month or so on MDI. So in essence if I get denied the pump I would have to
get to the point where I have bad control on MDI in order to be reconsidered
for the pump.
No insurance company in their right mind (So to speak) would want to pay
$6,000.00 for a pump then a couple of grand per year on supplies for a
patient who will probably live longer on the pump. They probably would
consider the cost of complications though as opposed to a pump. So many neat
little algorithms to figure out whether it is worth allowing the treatment.
Never believe for a moment that an insurance company has your best
interests at heart. Insurance is the biggest industry in the world. They
didn't get that way by throwing money away.
Forgive my rant :)
Cody S. Alderson
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