-B

>>

Sometimes, the best way is to call the Medical Management Office for your
insurance company. Ask to speak to the Nurse Case Manager. Explain what
machine you have, and unless they are going to provide one that is of higher
quality, question why they won’t cover the strips. It’s considered a
pharmacy item. If not, ask why not, and then start talking discrimination
against diabetics! Gently! Quite often, it works. Don’t just accept no
for an answer.
Then, get a prescription for each of your supplies from your Endo. Have
him/her write a letter of medical necessity for both your strips, how many
times per day you should test - -8-10, and for your infusion sets for insulin
administration.
Diabetes is a life-threatening illness, and pumping can help in reducing the
risks of complications……Joan:)

I just joined this group yesterday, but it looks like
I joined at the right time, as I’ve just had to battle
my insurance company about infusion set coverage.

My insurance company covers DME (durable medical
equipment) 50%. I realize this is more than some
companies, but as a recent college grad just starting
a "real" job, that means I’m still responsible for
quite a bit of the expense. I know policies vary from
state to state, as someone mentioned, but in Maryland,
insurance companies are REQUIRED to cover diabetic
supplies. However, there is no requirement for *how
much* they must cover, as I have recently found.

I went through the process of appealing my insurance’s
decision to cover only 50%, b/c according to their
definition of DME: "…able to withstand repeated
use…" I believe infusions sets should not be
considered DME. I also filed a complaint with the
Maryland Insurance Commission.

Unfortunately, this story does not have a great
ending, as I was just notified by the Insurance
Commission that there is no stipulation on how much
the insurance company must cover. However, I think it
is extremely important to know what the law in your
state allows and demands insurance companies to cover.
It’s hard to keep fighting an insurance company, but
worth it in order to get supplies covered.

Sorry to be so long winded for my first message, but
this is a topic I’ve been wrapped up in for the past 5
months! I look forward to hearing and sharing more
experiences!

Sarah

I know my insurance company only covers for a certain kind of meter. When I
had to switch insurance companies I had to switch meters. Chrissy

I am assuming that you talked to someone re: durable medical
equipment, not prescriptions. Most insurance companies consider the
infusion sets dm.

Did you ask if an insulin pump is covered under any circumstances?
If a pump is covered the supplies should be covered…it may be a pre-
auth issue or a pre-existent condition issue. Or simply that
particular brand isn’t covered as a preferred provider type issue.
Of course it could also be that your supplier isn’t on their list of
suppliers…

As far as the strips, most insurance policies now cover them as a
prescription med, when there is an actual prescription from your

physician. Are you buying them over the counter? Are you limited to
a specific brand/type of strips? In that case they should purchase
the appropriate meter for you. That is more often seen with HMOs
than other policies.

Will Cigna provide you with a case manager? They can sometimes be
very helpful in getting all the correct information to you. The ones
I dealt with at Prudential were great. They would go through the
policies and help me figure out how to dot the i’s without jumping
through all the hoops. My experience with Anthem case management so
far has been sadly disappointing…they are pretty useless, with no
power or knowledge re: diabetes and the policies/powers that be. I
don’t know about Cigna…but check it out.

By the way, where are you at Brian? Sometimes state mandates & laws
make a difference.

Suzanna

If you were buying a minimed infusion set I’d say call MM and have
them duke it out with Cigna, but I’m not sure if the other companies
do this as well as MM does.

I just started a new job recently and signed up
with and HMO thru Cigna. When I tried to order some
new infusion sets (disetronic tenders) for my
pump (MM 508) they told me that those supplies
are not covered. I also found out that they
cost around $275 per box. They also could not
fill my prescription for One Touch Ultra test
strips. Insurance companies are so lame but
I guess it’s better than nothing. I think.
If anyone has any suggestions I’m all ears.

-B