BCBS--re-reviwing need for pump and "ancillary" supplies after 2 yeras --WHAT!!????
So has anyone else had BCBS decide for no apparent reason after 2 years that they needed to review whether or not you "need" your pump and "ancillary" supplies (and yes I did fight them and win my CGMS--over a year ago)
I am sooo irritated...reported it to my HR..but noone thinks its urgent and the stress is phenomenal for me..
Just curious if anyone else has hasd this happen through private insurance (yes I know it happens all the time with medicare/medicaid and state run insurances)?
I am sooo irritated...reported it to my HR..but noone thinks its urgent and the stress is phenomenal for me..
Just curious if anyone else has hasd this happen through private insurance (yes I know it happens all the time with medicare/medicaid and state run insurances)?
Replies to This Discussion
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Permalink Reply by Denise Bevard on -
doctor is going to bat..he found it quite UNUSUAL..because nothing has changed....grrrr
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Permalink Reply by Terry Keelan on -
It may just be a paperwork routing bookkeeping nonsense as Dave says. That's the first thing that occurred to me, but you should keep an eye on it With health care reform at the top of many people's agenda these days I wouldn't be surprised to see insurers like BCBS scrambling around to get away with anything they can before the hammer comes down.
Keep your logs current and get your doctor on board. If you have any records or logs from before you started pumping, get them handy.
When BC started to cover CGMs I had already had one for over a year, but I submitted a claim to cover my sensors. I had to jump through hoops only to have them say "Well, his BG's look fine, why does he need a CGM?" Doh! My BG's were fine BECAUSE I was ALREADY using a CGM!! It was Alice in Wonderland for awhile until I was able to speak to someone who would look past the paper in front of their face and see the big picture.
Well, enough about me. It's probably just a routine paperwork thing.
But be prepared.
Terry
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Permalink Reply by Denise Bevard on
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I have saved all my log books--and all my appeal paperwork (having toi deal with workers comp and social security for 21 years does teach you some things besides ugly words about government run anything!) so that I will have..and have a great doc--and thankfully enough supplies for a bit....and MM might have to wait a bit for the littel more than 1K bill to get paid (my insurance co requires 3 month supply orders--on sensors too)
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Permalink Reply by Kristin on -
I had to do this once (though not with BCBS). They eventually approved it and said that it was just 'standard procedure'. I wanted to ask them if they know that diabetes in chronic.
Grrr....
Hope the process is painless!
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Permalink Reply by Mark on -
You're certainly not the first. See this discussion: http://tudiabetes.com/profiles/blogs/not-just-annoyed-but-angry-at
In short, my CGMS was approved, Dexcom sent the stuff and then I received a letter saying it was disapproved because it was an "experimental medical device, excluded from coverage". Very frustrating and it looks like I might have to send it back.
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Permalink Reply by marty peters on -
I had to win an appeal to have BCBS cover the monthly pods costs. Insulet rep was the driving force for BCBS to grant an exemption to how my monthly supplies are handled.
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Permalink Reply by Terry Keelan on
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Good point, Marty. Get the pump supplier to help, too. After all, they've got a vested interest.
Terry
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Permalink Reply by Denise Bevard on
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MM pretty much said too bad too sad my prob...guess they know I can't dump them for 2 more years....
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