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[IP] Re: insurance coverage for pump

At 05:12 AM 9/28/02, you wrote:
>My annual DME cap is $2,500, so what I'm trying to do is work out a payment
>deal for my next pump so that the payments stretch out over a "two-year"
>period -- even if it's just December of one year and January of the next
>year. Maybe you could stretch yours out over a period and get more than one
>year's cap on a pump. It would save you something ...
>Jan and Elvis

I'm checking over the booklet for my insurance and find that they show no 
cap for DME, just that it's covered 100%.  Another thing I found 
interesting is their description of DME,

"DME is covered when prescribed by your physician, and received from a 
contracted supplier.  The equipment must be medically necessary for the 
treatment of an illness or injury,"

(and this is the part that I find important)

"or used to improve the function of the patient's body."

I would think that, at least for my insurance, they would have a hard time 
trying to say that an insulin pump is not medically necessary since it 
would improve the function of the patient's body.  Hmmmmmm.  Perhaps that's 
why they paid for mine immediately, no questions asked.  This is BC/BS of 
Michigan, Community Blue PPO Insurance.

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