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Re: [IPk] Re: Funding

> 2) As I understand the position in USA the Insurance companies pay
> for Pump therapy. This would only happen on economic grounds ie in
> the long term it will be cheaper to treat IDD with pump therapy
> (where appropriate) because of long term benefit. I think someone
> noted earlier in this debate that NHS in UK only budgets to the end
> of next week. Hence the problem.

It doesn't really work that way. The way insurance policies are 
written, it is a take it or leave it proposition for the consumer. 
Because of that, if there is a legal argument about what the policy 
says, if the insurance company forgot to mention something, it's 
tough for them. Since no policies specifically exclude pumps and 
since pumps are "standard and accepted" therapy, if a letter of 
medical necessity is written by a doctor, the insurance company must 
pay. That's not to say that they don't deny the benefit, many of them 
do. They use a diversionary tactic of saying they have internal 
"policies". Basically the engage the insured in a an argument about 
blood sugar levels, hba1c's, age, etc.... that has nothing whatever 
to do with the language and obligations contained in the contract of 
insurance. Once a hole has been poked in the diversionary tactic, 
they capitulate and cover the pump. Unfortunately, many people accept 
the denial at face value and don't carry it further.

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