I have been screwed by my insurance and/or pump company!!!

[paddbear0000]

Warning...this is a rant!!!   

I have trying for the last month and a half to get one of MiniMed's Continuous Glucose Monitoring insulin pumps. Ii desperately need it because after 25 years, my blood sugars have become so unstable that I can't control it. Plus, I can no longer feel low blood sugars until they are in the 40s. It has been such a pain in the butt because my endocrinologist kept returning the forms to the pump company without filling  out the letter of necessity section filled out. After 3 attempts and a visit to the office by the pump company's field rep, she finally got it right. Our BCBS has a $4000 cap on durable medical equipment i.e. a pump) plus we were to get a $500 trade in value for my current (and dying) pump. The supplies for it were supposed to be covered by the prescription portion of our insurance. They always have been. MiniMed quoted us $671 out of pocket for the pump, glucose monitoring system, wireless glucometer, and supplies. And we were going to do their payment plan of $50 a month. Well, I get a call an hour ago from the pump company rep I've been working with, and she tells me that she found out that BCBS's prescription coverage does not have a contract with MiniMed this year, so my supplies now will be covered under the $4000 cap, which will be more than maxed out by the pump, so we will now have over a $1000 out of pocket cost, plus have to pay thousands of dollars through the year for the infusion sets, cartridges and glucose monitoring pieces!! There is no way in h*** we can afford that!!! I am so upset now because I'm not going to be able to get the pump. I really wish they had figured this out when we first started, I would never gotten all excited about all of this and gotten my hopes up!! Now I have to continue with the dangerous ups and downs!!!     

[G-Ma]

I am so sorry...this seems to be """the""" week.           

[jbeany]

That does suck!

I'm on what my doc calls "the poor man's pump".
I check glucose before every meal or snack and before bedtime, and readjust my sugar with a bolus shot every time, or with some form of carbs if it's low.  It's not unusual for me to check it 10 times a day.  It's annoying sometimes, but it helps!

[Chris]

Are you wilingl to try another manufacture that has the continuous glucose monitor? Maybe BS will cover that brand. Though if you fight hard enough and your doc helps out, the insurance company may then help cover the cost just for you. This has been reported in the news a few times. Also try your transplant center to get involved with the necessity part, with them explaining how this new pump can cut cost to them by keeping you out of the ER and hospital.

Keep your hopes up and options open.
You should apply for Medicare and Social Security. They paid for my pump and supplies and will help cut cost on your insurance by not meeting your max limits. Although that was discussed in another one of your post.

Another thing to think about is talking with a diabetic educator who trains people to be on the pump who has experience with a varitey of pumps and just not one brand. Some know who will be covered by what insurance or be able to get you hooked up. Local Hospital or Transplant hospital maybe best due to the number of resources they have.

[Wallyz]

Remember, Paddbear, "We don't deny treatment, we deny payment" 



I'm so sorry. I hate dealing with this stuff. 

[David13]

I think Chris has a very good suggestion.  Check with your insurance to see if there is a company with which they DO have a contract. 

It's worth looking into.  It might not be the exact pump that you wanted, but it might still help you with monitoring your blood sugar levels. 

[paddbear0000]

Yeah, they do, but unfortunately, it's the pump company I'm using now. And I hate this pump. Plus, I got it when I had no insurance, so we are paying the full $5000 on it out of pocket. To tell the truth, we kind of stopped paying on it about a year ago because we just can't afford to anymore. They don't make a cgm pump either. Actually no one else does except minimed. Others make a cgm, but they don't work with a pump and our insurance doesn't have contracts with any of them. I need the pump to do some of the work for me since I have so much trouble detecting highs and lows and I really have problems when I'm sleeping.

[paris]

I am so sorry...this seems to be """the""" week.

You are so right G-Ma!   PaddBear, it just seems to be one thing after another, doesn't it?  I am sorry. 

[Chris]

I still say put up a fight, the peraon on the other end is basically an idiot who is only looking at some book and not how real life works. It may take a bit, but the more you  "bitch" at them, the better and have as many doctors stick up for you on his need.

Plus, GET YOUR BUTT TO THE SOCIAL SECURITY OFFICE! Get on Medicare now that your on dialysis and then go get your pump after everything goes through. You will meet your insurance quota for coverage limit in no time with dialysis and then you and your husband will be without insurance till all that is cleared up, however tat works. Like taking a test, use all your available resources around you.

[twirl]

what the hell is wrong with the world

[kitkatz]

The world pretty much sucks, medical field and financial fields more so than others.

[paddbear0000]

Found this in my My Documents folder. I forgot I had it.

[twirl]

paddbear     a picture is worth a thousand words 

[paddbear0000]

I may be getting the pump now after all. I received a coverage certification letter from my insurance company in the mail on Tuesday, so called them because I was truely confused by that point. I found out that the supplies are not covered under the durable medical supplies or the prescription coverage, but rather is covered as if they were doctor's appointment (if that makes sense). Apparently the pump company misunderstood one of the codes. So I immediately called my pump company rep and spoke with her. She told me to send her a copy of the letter, so I told her I would scan it and e-mail it to her. She said she would look at it, and let me know if everything was a go. I ran upstairs and sent it to her, then called to make sure she got it, but had to leave a message. By Wednesday afternoon, I return call. So I called again Thursday morning. No return call. I call again Friday morning. No return call!!! Now I'm getting pissed!! If she doesn't call me by 11:00 am EST Monday (she's in California), I'm trying once more, and if I get her voice mail, I'm going over her head! This is ridiculous. y insurance company needs to reapprove coverage every month and at this  rate, we're going to have to start this whole damn process all over again. I just spent the night before last puking my brains out because my blood sugar was running over 600 all night because my current pump's motor is dying.