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Don’t know what to do. Denied again.

Insurance has denied my doctor’s appeal for coverage of an insulin pump and continuous glucose monitor, again.

Feeling very hopeless and helpless right now.

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5 Comments so far (Add 1 more)

  1. Hi L,
    Yes I, and my nurse, are looking into getting support from grants and trusts. Unfortunately I am finding a lot are based on financial need. I do make a decent living, before you subtract all of my extra-ordinary medical expenses. CF is a very expensive disease. These other expenses aren’t usually considered when the organizations are giving out financial support. I am still looking though!

    But first it is the job of my health insurance company to pay for this. After all that is why I pay my monthly premiums! Plus, even if I don’t get it covered, I will feel a little better fighting this knowing that I am raising awareness about CFRD.

    Thanks for the suggestion.

    1. aspen on February 19th, 2008 at 10:59 am
  2. in addition to contacting the pump companies, there are cf grants and trusts that can help pay for needed medical supplies. have you looked in to any of those?

    2. L on February 15th, 2008 at 11:43 am
  3. Hi Aspen!

    I just found your blog today by chance, and I wanted to wish you luck on your journey to an insulin pump and CGMS. I have a minimed and their CGMS, and love my pump but don’t really trust the CGMS… it’s not as accurate as it could be. Have you tried contacting the pump companies and asking about a trial? Or asking your doctor to do that? Once you get a pump, it might be wise to try out the CGMS before buying, since it’s so expensive and not covered. The pump itself will help a lot with getting a more stable reading through the day.

    I’ll keep you in my thoughts, and it’s nice to “meet” you! :)
    Beth (in search of balance)

    3. in search of balance on February 13th, 2008 at 5:28 pm
  4. Hi Jesse,
    Hearing from you brightens my day.

    I have Greatwest Healthcare. I also had GW-H when I worked for the state government. My new policy has horrible coverage with high deductibles, high copays and a ton of coverage denials. The policy I had with the state had tolerable deductibles and copays, and I didn’t have nearly as much trouble getting things covered.

    I think I read somewhere that Aetna would approve an insulin pump for anyone with an A1C (average sugar levels over 2-3 months) higher than 7.0%. My A1C is 9.0% (out of control, way to high). My company apparently only covers pumps for strict Type 1 diabetics with bad control of their diabetes. Guess some companies appreciate preventative care more than others!

    I will be getting a second opinion, just for insurance’s sake. Fortunately, my doctor IS one of the best, and was the one who jumped for joy when I asked to get a pump. She really thinks it would help me out. The road bump, or mountain should I say, is the insurance company.

    4. aspen on February 13th, 2008 at 4:10 pm
  5. If you don’t mind, what insurance and plan do you have? I have Aetna HMO and have only had one problem in 7 years and am curious as to which ‘bottom-liners’ are not interested in actually improving one’s diabetic health.

    Have you considered getting a second opinion from a doctor to make a second appeal for you? Denver is supposed to have one of the best programs in the country, and I’m amazed that they can’t pull the strings for you.

    Don’t give up!

    5. Jesse Petersen on February 13th, 2008 at 12:48 pm

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