pity party, A1c rise = pump denial.

Well, last I was here I'd just been informed by my insurance that 6 months after approving the pump they were going to deny payment. They are basically claiming they never agreed to pay anyway and if I have a problem with that it's Medtronic's problem. At first medtronic said that if the insurance won't pay then I have to, even though the miss-communication involved the two companies and not me. Thankfully Medtronic has great customer service because after a couple horribly depressing phone calls with them, the original people who helped me get started began to call to reassure me that they were going to help me appeal. I know they are trying to get their money but they have still be tremendously helpful and proactive.
After the run around with my insurance they finally admitted that the reason they are denying me, is that since being on the pump my A1c has risen, therefore I was doing better on MDI. Funny, considering that of the 2 A1c tests I've had since starting the pump, only one was during a full three months on it. Also the rise was due to knocking out the nearly daily episodes of hypoglycemia. Wow, just wow. Not to mention the results covered probably the most stressful months since my mom died, and I was/am still learning how to make the pump work as hard as it can for me. Not much of a trial period there. Anyway now I have to take a new a1c in hopes it has lowered, though I've been dealing with the insurance b.s. this whole time, and I've
definitely noticed my control wavering. I wish they would leave me alone
and stop trying to bully me for 3 months and then see the difference.
seriously
So now my Dr. (who is AMAZING) and my local Medtronic team is helping me gather all required for an appeal. They feel very confident and while I feel I've done everything on the up and up, part of me feels like it's a losing battle. And the idea of going back to shots makes me want to cry.(i don't know why this is making me so emotional, it's very unlike me.) The pump has been so much better for my life, for my family....i was so scared to start the pump but I had enough lows to know it was only going to result in a hospital stay or worse and I can't care for my siblings properly if I'm in the hospital. It's just too much. I homeschool my brothers and sisters, I take care of a household...my schedule is so random and varied that on shots I was always playing catch-up...usually not very well. It's so much easier to change things in the moment. But the advantage is not the bottom line for the insurance, they need to see how it will save them money to keep me on the pump. So documentation of lows and proof of safer control is key.
Also they denied my last order for onetouch strips, I called today to find out why, apparently they've switched to freestyle. I wonder if this means they would cover a different brand of pump. It's all become so ugly and complicated. I've spent hours of the phone, in the dr. office, on the computer loading my numbers into sugar stats. All of this time has been taken away from my family and that infuriates me. Thankfully, being a "stay at home sister" has allowed me the time to do all of this. I think they count on working folks not having the time to put up a fight.
OK, I've had my little pity party, I've gotten it off my chest. I know that I am so fortunate that there are a million and one worse things in the world to worry about/have happen to you. Despite the previous writings, I am indeed thankful. I just needed a space that was safe to vent.
Thank you to all the people here who have helped me without question. You never fail to support someone in need and it is most appreciated.

Views: 8

Comment by Devon on March 15, 2010 at 10:31am
Isn't this site great. I just posted my own little pity party blog too. In a sick way it is nice to know others have the same issues you know?! Well, I just wanted to say I enjoy reading these because it is a reminder that I'm not alone. I wish you good luck with all you are dealing with. Insurance companies suck but we can't survive without them sometimes. Keep your chin up... it has to get better sometime right?!
Comment by Joe_h on March 15, 2010 at 12:01pm
sorry for your troubles. keep fighting 'em!!
Comment by Michael Wiggins on March 16, 2010 at 10:56am
Ish,

You may eventually have to head to the insurance commissioner office for your issues. I have been is the business for 30 years and everything you have stated in your email doesn't chive. They can't go back on an approval if you have it in writing, also they don't practice medicine so just because your A1c went up means nothing. Look at your booklet or policy to see if it has a external appeal process - its law in many states. Even if your policy is self-funded and not under the purview of the department of insurance you have rights - and they have fiducary liability. Is this group or individual coverage - sorry I hope you know the difference. If Medtronic can't get you where you need to go lat me know! Mike

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