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Re: [IPp] Pump, insurance help (long)



Mike, you have my sympathy........dealing with
insurance stuff is not my cup of tea either.....will
the doc allow the pump trainer from the pump company
to do the training if this isn't resolved for ins. to
foot the bill?   Good luck, Vicki.



--- Mike Swaithes <email @ redacted> wrote:
> With the number of people on this list, I am hoping
> someone has some
> suggestions to help us get thru what is going on
> with the endo and
> insurance.
> 
> In a nutshell, we have a pump, and can't get
> trained, unless we can/will pay
> $1,620 to the endo for training.
> We were approved for the pump, 80/20, ok I can live
> with that. $1,000+/-
> Called ins, "our endo requires a training class for
> all pump patients, is it
> covered?" YES 100%
> Finally get the training class scheduled.
> Endo sends in pre-approval for the training class.
> Sorry, ins denies, saying
> pump training is included from the pump
> manufacturers. But wait, the pump
> CDE can't train patients of Children's Medical, due
> to an agreement they
> have and Children's will not allow training from the
> pump rep(CDE). The endo
> wrote a letter of medical necessity and still the
> ins denied it. If the endo
> deems this medically necessary and the ONLY way they
> will support a pump
> patient, how can the insurance deny it?
> 
> So we have a pump, and unless we want to change
> endo's or pay for the
> training class, we can't use it.
> The insurance is Blue Cross Anthem COBRA $875mth
> with NO handbooks, coverage
> information or anything available to state exactly
> what's covered, irks me
> just thinking about it.
> 
> We have escalated it within Children's (no cigars)
> and are waiting to hear
> back from the person who denied it at BC before we
> escalate it there.
> 
> Any suggestions would be greatly appreciated.
> Mike Swaithes
> Dad to Alicia 9 & Lindsey (Z) 12, dx 5/98
> 
> (Sorry to those of you who get this on both IP and
> IPp)
>
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