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Re: [IPp] GlucoWatch appeal

I think insurance companies routinely turn down the first attempt to get 
approval and then routinely deny the first appeal.

When you show up in person, I think your chances improve greatly.  Our 
insurance turned us down on the first request and first appeal to pay when 
Gabe went to Dr. Bernstein.  When we went to the next level, it was a 
committee; there were about 5 doctors, 6 nurses, 5-8 CDEs and some executive 
types there, totalling about 30 people.  Gabe came along with me and my 
husband and we had twenty minutes to present our case.

They ended up paying for Dr. Bernstein's charges, although he is not part of 
our HMO or PPO network.

In my 21 years in practice, I don't think I have ever seen an insurance  
request be honored without going to the third level of appeal.

IMHO.  Also, if you can show that other insurance companies are paying for 
the Glucowatch, your case will be much easier; once a big insurance company 
decides to pay for the watch, then you can argue that it is the "standard of 
care" and your insurance company is basically forced to pay as well. 

Good luck!   We are working on getting a watch for Gabe.  Just out of 
curiousity, we are letting the Glucowatch folks do the insurance stuff for 
us; apparently they have a division that does the letters of request and the 
first level of appeal; we haven't had to do anything but request a 
prescription from our doctor.

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