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[IPp] Re: pump replacement



Mary and Tammy,

I got to the Aetna nurse case manager when I questioned what I was told by 
the dur med. equipment dept.  I complained to my DH's employer (a national 
self-insured comp that uses Aetna as their administrator) and was assigned a 
corporate Benefits Advocacy Rep who told me the same thing about having to 
prove a broken pump off warranty could not be repaired before getting a new 
one.  Then I was a ssigned this nurse case manager who said the same thing.

I will touch base with my endo, BUT they are about 200 miles away where DH's 
company and their particular brand of Aetna are not a swell known.  We live 
in the city where this national comp is headquartered and I bet the ped endo 
here would know more.

I have a year before the warranty runs out, BUT Aetna's inability to answer 
questions over the last year made me ask early.  They all understood I was 
talking about a future replacement when the warranty expired because they 
each one chastised me for "worrying" this early.  Of course it took them 
three weeks to clarify the policy which I questioned, and in both cases they 
they are talking about a "repair" that Animas won't do.

You'll find this interesting...at this point the pump replacement (i.e 
process, approval, and reviewing dept at Aetna) is the same as that for the 
CGMS. That doesn't see right. I appreciate your strong responses as I was 
blown out of the water.

Does anyone know if there are any legal or advocacy issues I can push if 
they try to do this?

Thanks, Tracy

----- Original Message ----- 
From: "David & Tammy Tyms" <email @ redacted>
To: <email @ redacted>; <email @ redacted>
Sent: Tuesday, July 29, 2008 7:57 AM
Subject: RE: pump replacement


> Tracy
> I think I would do some double checking with your benefits coordinator.
> Another good person to check with is your CDE and/or your endo.  They
> may be able to tell you what has happened in the past when they have
> dealt with Aetna thru other patients in the practice.  I'm not saying
> your case manager is wrong, I'm just saying I would do some double
> checking. I have been told many times that things would not/could not be
> covered only to find out later that the person I had been speaking with
> was not well versed on our policy/benefits.  My dd has been pumping for
> almost 8 years(3 different pumps- 2 different insurance companies) and I
> know a dozen others who have been pumping almost as long or longer.  I
> can't say for 100% certainty, but most have all received replacements
> once the warranty runs out.  I have often heard that many insurance
> companies do not do any upgrades until the warranty runs out, where as
> others do it as long as the endo provides a letter of medical necessity.
> Is it possible that maybe the case manager was thinking you were looking
> for an upgrade before the warranty is out?  I'd say keep digging around
> to ensure that the case manager is 100% correct.
> Just my thoughts.  I really, really hope this works out for you.  How
> soon is your warranty up?
> Tammy
>
>
> Date: Tue, 29 Jul 2008 00:08:30 -0400
> From: "Tracy Winsor" <email @ redacted>
> Subject: [IPp] Re: pump replacement
>
> I wonder if anyone has any insight...
>
> We have Aetna insurance, and I'm trying to find out what happens when
> Ben's
> pump goes off warranty.  Animas seems to think that when the warranty
> expires most insurers provide for a new pump.
>
> A nurse case manager at Aetna advised me that we will not be able to
> replace
> it until it breaks, and then only if it cannot be repaired!  AND even
> then,
> I go back thru a precert procedure that requires we prove medical
> necessity
> all over again.
>
> Does anyone else have experience with Aetna and getting a pump replaced?
>
> Tracy
.
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