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Re: [IP] Sorta OT but kinda relevant

    > Respectfully, I disagree. If a doctor prescribes a >pump and writes a
letter of medical necessity, the >insurance company can not contravene the
doctors >
>order .... that's called "practicing medicine"

    According to what I now understand about my HMO when my doctor
recommends any type of treatment for a disease it is open for review by
insurance company doctors to decide whether agree with the PCP's assessment
of being appropriate and of medical necessity. So, even though my PCP may
say pump therapy is the best way to go the reviewing doctors for the
insurance company could say that MDI is better for me. Of course a battle of
wills and evidence will ensue if that happens, but it is a worst case

>. . . Be persistent, and when and if denied at the final >appeal level,
file a  complaint with your state's insurance >commissioner. . .

    I do believe almost any insurance company will relent if the matter is
pursued, and I intend to pursue it to the ends of the earth. However, just
with the stroke of a pen they can say no. Then I have to prove my side while
they prove theirs and I wait for the pump. I am not expecting this but it is
a possibility.
    I believe that the reason that not one in the history of
Insulin-Pumpers.org has been denied is only because IP is here to let people
know to fight. I wanted a pump years ago and they told me no (Different
insurance) I didn't fight it because I thought they had the last word.

Cody S. Alderson
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