I just received a letter from Anthem stating that they are denying my omnipod…I have been wearing the pod since July 2009…Their clinical claim reviewers state that I have not seen my Doctor atleast 4 timesin the last year…[yea right]…that a diabetes educational class was not completed within the last 2 years,that there were frequent adjustments of insulin doses for the past 6 months,and the number of glucose self-testing of atleast 4 times per day during the last month,therefore this claim for disposable insulin supplies is denied as investigational…wtf…you got to be kidding me???sorry for the rant,but I am having a total meltdown right now…sigh…
Better Buisness Bureau and your states insurance comission.
Can you prove youve seen a CDE or your Doctor, even an email contact usually will suffice…
And how often are you testing… you can submit logs as proof of testing… I wish you luck…
I had to prove I was doing all of the above before seeing them…
Also a Dietitian/NP/Etc usually counts as a diabetes education class…
Best of luck
I faxed a copy of the letter to my Drs. office last night …So Hopefully he will call me back today…I know that I’m not the only one that has ever had problems with an insurance company,but it seems like everything has been going better…I have a Drs. appointment on the 23rd,and my blood sugars have been running a lot smoother these past couple of months.yadda,yadda,yadda !!!.so anyway,today is another day,I’ll keep up the fight!!! Thanks everyone!!!
Appeal, appeal, appeal. The game is that they expect you to fold. I was with Anthem for a year. Give a little pushback and you are very likely to get approval. And great for you getting your doc on board!
Hi all, after speaking with omnipod rep ,I was assured that all of the confusion would be straightened out with Anthem…I was told not to worry about anything ,they would fix all of the problems …I was also told that there are many other people that Anthem is trying to do this to as well .Guess what?Today I received another denial from them only this one was dated back to june 2009,{Before I actually started wearing the pod.}…reason code:{frequent daily blood sugar checks with poor control despite frequent insulin injections.}…I am beyond words at this moment…what don’t they understand…HELLO,I have brittle diabetes and I am trying to get it under better control…Tommorow I have a Drs. app…we will see what happens…p.s. sorry to be ranting again,I am usually a very pleasant person…peace:}…
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