Annoyed by my insurance company

Even when you have decent insurance, the headaches keep coming. I just got a letter from Anthem - you know, the “good” insurer who was willing to pay for Eric’s pump? It says, and I quote, “…it was determined that benefit coverage for the above listed service(s) is not approved for the following reason(s): we will not provide coverage for an insulin pump. Records sent do now [sic] show a log showing at least one month of attempts to reach good control with frequent insulin dose adjustments and that the member has been seen by their doctor at least four times within the last year.”

Eric has been seen MONTHLY for the past year, sometimes more frequently than that. Our struggles to achieve decent control have been thoroughly documented–I have reams of paper and several computer files showing the ups and downs we’ve had. But none of this was sent to the insurer because no one bothered to mention it would be needed. Heaven knows, if anyone had told me “you’ll need to document that Eric has had regular trips to the endocrinologist and that you’ve tried to get good blood glucose control for at least a month” I’d have been happy to put the paperwork together. Apparently that little detail slipped the minds of my friends at Medtronic when they assured me they’d bill Anthem for me.

Do I need this aggravation? No, clearly not. But at least it comes the weekend before my half-week vacation. So now instead of spending the vacation chillin’ and regaining my equilibrium, I’ll spend at least part of it appealing Anthem’s decision, presumably with a little help from Eric’s endocrinologist (to whom I sent an email last night asking for backup when I realized the futility, and possible counter-productivity, of sending a nasty-gram to Anthem).

Just another item for my book…

Yikes… at least you have all the documentation to back up your case on appeal though, and that will make the process much easier for you since it sounds like you’re very organized :slight_smile:

I hope it works out for you - but I agree, we DEFINITELY don’t need this kind of extra stress just to use our insurance benefits!