I (or rather Minimed) submitted a request to my insurance for the CGM that works with the Revel insulin pump at the end of September. The insurance turned around and denied me based on the "lack of records of two or more episodes of hypoglycemia less than 50 mg/dl in the past 30 days." So, with the help of my rep from Minimed, we assembled the record of my levels for the past 30 days and submitted an appeal to the insurance. The records clearly indicated two episodes of hypoglycemia. I find out today that it's still pending and the insurance has until October 29th to make a decision.
The following is the rant in my head right now: Well, excuuuuuuuuse me insurance company. I didn't know it would take you that long to decide whether I should get a piece of medical equipment to help keep myself in good control (aka ALIVE). Isn't it great that you have to basically in absolutely horrible control to get any coverage whatsoever?
I don't know why people are so worried, Insurance companies are already run by number crunching bureaucrats, not people interested in "health" or how their business actually effects people's lives. A few more bureaucrats probably won't hurt. =(
Medtronic screwed me, because they ran my supplies for my Paradigm through DME and I ended up with a 90-day supply and a $700.00 bill.
When I called to ask if I could make payments, their answer to me was, "No. We must receive it in full."
OOOOHHHH OKAY!!!!! Well, what are my options?? Send the supplies back?? Okay. Have the UPS guy come to my door and pick them up, because I am broke as %&^*( and can't afford my medical supplies and/or medication.
Seriously. I have insurance. And they want $100 for a 30-day supply of the flex pens. Are you kidding!!? I have to beg my endo for samples.
I had issues continuously with Medtronic and have now switched to Omnipod but the insurance coverage isn't any better. I've gone through $2500 in flex and it's May. I have no idea how I'm going to make it through the year, thinking of going back to MDI but my control with that is pretty bad and lots of lows so I'm not really sure what to do.
I had issues with that too. I don't remember exactly what my parents did, but we ended up getting it eventually. Their excuse was that I didn't have hypoglycemic unawareness, but since I can't tell I'm low until I'm at least in the 40s the diabetic educator wrote a letter I think. I hope it turns out well for you, after a few months w/CGM I quit using it, just wasn't working for me. It took me really long to get my pump too. I was 11 and I literally did a victory dance when my mom told me the insurance finally approved it, after a year and losing my paper work =P (I've had diabetes since I was 1 so 10 years of MDI is a lot)
we fight with insurance all the time... the current argument is wether or not 100 test strips is enough for 30 days. They say it should be way enough. We, and the doctors, say that i need to test >4 times a day, contrary to what insurance says (4 max)... let's do some math- 4 tests/day x 30 days = 120 teststrips. insurance drives me nuts! What happens if I'm low? that's another strip used... stupid insurance people :P
All i have to say is that I agree with every last one of you!!!!! =) I couldn't possibly say what I want to because my mouth and my language would probably get the best of me. =)
Insurance companies and some doctors make being a diabetic that much more difficult. Recently I had to reorder my supply of insulin. I use Medco mail order because it is MUCH cheaper than through a local pharmacy. I got a prescription for my insulin way back in February during a visit just in case I needed it when my refills ran out. I got it during my visit because my endo charges $10 for refills or insulin dose changes made between office visits (a bulls**t policy, IMO, but that's another subject).
Well here it is May and I need to reorder insulin and I have no remaining refills on my current prescription. I thought I would submit the prescription via fax to the mail order pharmacy, but I failed to recognize that a prescription is a legal document and I can't just fax it. They said I could mail it, but it would take 2 WEEKS to even process! They asked me to ask my endo to request a special fax form via a "secure" fax line to submit my refill. Did I mention that my endo doesn't do faxes unless you pretty much beg them to? I had to get them to fax it in, and they did. I am thinking of switching endo's because of these policies.
I know this was about insurance companies, but this topic made me think of this incident.
Never had any of the issues outlined above. I guess I am a lucky one. Medtronic has always been good with all the insurance paper work and multiple insurance companies I have had. The ounce was a time I had no insurance, and that sucked even more. Food for my family, or insulin. To test, or not to test. Can;t afford a doctors visit. On and on. I am very greatful today for having health insurance, regardless of the cost.
Someone should remind the insurance companies about how STRESS effects a diabetic, and how their poor decissions can impact us all.
Seriously, it they're worried about the bottom line there company is covering, they should look at reports of stress, what causes it, the implications on management and how much more that management is going to cost them in the long run vs. the healthy control of an individual! ;lakjsdf ;alskdfj