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Re: [IP] Re: insurance coverage for pump



Our insurance, Aetna, covered 100% of Jenny's Animas pump. They also 
cover supplies completely. The only copay we have is for insulin and 
doctor's appointments.

RoseLea wrote:

> 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.
>
> RoseLea
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