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Re: [IP] Re: [IPy] Frustrated



I remember a fight to gdequate strips per month. My MD wrote the Rx to cover
10-15x a day. I supplied this schedule:
1) Upon waking
2) before breakfast
3) after breakfast
4) before lunch
5) after iunch
6) before the gym
7) After the gym
8) Before dinner
9) After Dinner
10) Before going to bed
B 
And then I threw in all the times before I get behind the wheel of a car, or
my schedule changes - e.g. a later bedtime.
"They" had to admit that 10x wasn't extreme and even said they were glad that
I tested before driving.B  Try it, it may help. You could write it for the MD
to sign as part of the Rx.
B 

----- Original Message -----

From: email @ redacted
To: email @ redacted
Sent: Sunday, April 6, 2014 11:15:56 PM
Subject: [IP] Re: [IPy] Frustrated

> B Right now, my endo writes for 8 strips a day, but insurance is saying
> B I only
> get 200 strips per copay, so I get 25 days worth for one copay. If he
> wrote for ten per day, my guess is I'd get 20 days for one copay. I'm
> working on this. It's hard to get the people in the endo's office to
> understand what needs to be done to get the 30 days supply for one
> copay. I already had to switch back to one touch from contour because
> of this insurance - which is fine. Minimed supplied them under the old
> insurance, and I didn't have to deal with a limit.
>
> Luckily I have a flexible savings account to help pay for stuff.
>
> Stacey

I've done this over and over for Lily. This is what works every time.

Make sure you are talking directly to your insurance company, not the
pharmacy supplier. The pharmacy supplier is a 3rd party provider
under contract to the insurance co. If they provide you with strips
over and above WHAT THEIR CONTRACT WITH YOUR INSURANCE CO. says, the
don't get paid so their not gonna do it. You must speak with the
pharmacy manager (or some similar title) at your insurance company.
The try hard to screen the calls so you can't reach that person but
if you persist you will succeed in reaching them.

1) Make sure the doc writes specifically that you are to test 10x per
day so that if they don't want to do it then they are "practicing
medicine".... and you can ask the question "are you telling me what
my medical care should be"? "are you practicing medicine"

2) ask specifically where in YOUR COPY of the contract of insurance
it says that strips are limited to (whatever). Make sure you read the
section on diabetes supplies so you can quote it back to them with
the page number and paragraph number.

3) definetly appeal TWICE. Make sure you document the time and date
of each contact and exactly who you speak with. There is no 3rd time.
The third time goes directly to the state insurance comissioner with
a complaint that your doctor has prescribed specific medical care
which is covered by your policy (quote page and paragraph and include
a copy) and they have refused to provide the care ... and in addition
that they are practicing medicine by countermanding the doctors
specific orders.

Of course, the third letter will never be written because they will
cave in. KEEP the records for each time you have to do this so that
you can quote back to them next time, the dates, who you talked to,
the dates of appeal, the outcomes, etc.... after a few time, they
will probably stop hassling you because they will figure out that you
are not an easy mark. I've had to do it 4 or 5 times over the years
but it all stopped about a half dozen years ago.

Michael
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