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[IPp] GlucoWatch appeal

For those of you following my GlucoWatch appeal (I had sent in an
appeal letter with 7 supporting documents to the military
insurance, TriCare, about a month ago), I finally heard back from
them the day before Thanksgiving. They upheld the original
decision and denied me again. Our endo is po'd and thinks they
are just stalling (so do I). He said my appeal and documents more
than proved the safety and effectiveness of the device (which was
the issue in their first denial). Seems they've switched gears on
me, however, and now the issue seems to be whether it is
medically necessary or not (very difficult if not impossible to
prove that, short of allowing my daughter to seize.) I don't see
how they can do this. I addressed the only issue they had with it
(the only one they ever mentioned) and gave them exactly what
they asked for (peer-reviewed articles, clinical trials, etc),
and now they've upped the ante, asking for the impossible (and
they know it). In this latest response, it was very apparent that
they hadn't read my appeal letter or ANY of the documents (which
they asked for!!! And I spent a month+ working on it.) I have 60
days to respond and our endo said before I do, he wants to look
into some things for me (ie: what other TriCare regions are doing
etc.) He said if they are covering it then we may be able to
complain. I have 2 more levels of appeals to go through and one
or both of them are in-person (ugh!) That's okay, I have a
strategy in mind (anyone ever seen Legally Blonde? LOL!) ;)

Take care, Kerri - IM me on MSN: maverickmom1965
Parents of Pumpers chat host, Saturdays 9:30pm EDT, Parents chat
room at www.insulin-pumpers.org
"doce ut discas" (teach that you may learn)
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