I just received a notice from my insurance that they aren’t covering my pump. About 2 weeks ago they sent a notice saying that the Dr. prescription was pending. I called and they said they did get the paperwork from my Dr. and it was still pending.
This is all very weird because in Sept 09 Minimed approved everything through my Insurance and I’ve been pumping since then. Is it actually possible that my insurance has let me have the pump for 6 months and is now going to deny my coverage? I know it’s Saturday and I can’t do anything about it until Monday but has anyone had this experience?
I was told from the beginning that I was 100% covered, I asked them if I had the option to stop the pump request if it was only partially or not at all covered and Minimed said that they would call and tell me how much the insurance was willing to cover and I could choose to go ahead or not. They did in fact call me and told me that I was approved for full coverage. I don’t get it.
Do I also need to call Minimed? I’m starting to worry it was all a big trick, they would get the pump to me, my insurance would deny it after the return period and then I would be obligated to pay.
What are my rights here? How should I prepare myself for calling them on Monday? Do I call my Dr.?
I’m really confused. Any help or advice would be so appreciated.
There’s no way I can take on this expense, and given then option of paying it out of pocket or not having it I would have stuck with MDIs until I could afford it. But to be told you’re approved and have it all settled and then told suddenly that you aren’t covered…that’s just messed up.
Call the insurance company and ask why the change in coverage. Ask the insurance company what is to be covered and not covered as far as your diabetes is concerned. They may not be willing to tell you that but at least try. Contact your job and see if they changed what is to be covered and not covered. Ask your job to supply you with a printed copy of what should be covered and what is not covered. You will probably find out that your pump should still be covered and someone made a “mistake” in telling you that it is no longer covered.
I am hoping it is just that they need a little more information from you or your doctor and then they will re-approve your pump.
Good Luck it is worth the fight.
I would really get in contact with both medtronic and your physician. Medtronic really, really wants you to continue being their customer and they will fight for your coverage. They have teams of people who only deal with insurance companies and issues like this. I would also call your physician, because this may just be due to an expired prescription or something simple like that. Ultimately, you need to speak to the insurance company but I would get medtronic on board as well.
Appeal. Appeal. Appeal.
It’s a pain, but it usually works. The insurance company tries to get out of paying for anything. Usually it is the most effective if your doctor contacts them. But you should also contact Medtronic and see how they can help (they WANT you to be covered) and the insurance company directly.
When I first got my pump in 2004, I had to appeal the original decision. After 1.5 years of pumping, I got a letter from my insurance company that they had decided that the pump was no longer “medically necessary” and they were suspending funding. (I was wondering if there was some cure for type 1 that I hasn’t heard about…). Bascially I just had to call them, have my doctor right to them and the decision was overturned and they kept funding my pump, but it caused quite a bit of stress and lots of wasted time.
If Medtronic is the one that told you that it would be fully covered, then I would start with them. If your insurance does not think that it is medically necessary – then mention to your doctor that you have had some nighttime lows that scare you (you have gone low at night, right? That’s always scary and the quickest way to get the pump approved. Your insurance would rather pay for a pump than ER bills from midnight hypoglycemia.)
Had almost the same experience with BCBS. Mostly it was Minimed’s fault for not properly supplying the insurance company with all the forms they needed. I got my company’s insurance broker involved and my pump was paid for in about a week after going through at least two month of not knowing if I would have to return it.
Thank you so much for your reply, I was very nervous. I called Minimed first and they agreed to investigate it. So far the insurance still claims it’s pending. Minimed said if they send another notice or decided they aren’t going to cover me, they have all the paper work and recorded phone calls from my insurance giving the go ahead and they will fight them. So I guess I just have to wait and see, I’m at least glad that I have my Dr. in my corner and that Minimed was so helpful.
Thanks again, fingers crossed!
this was very good advice, as soon as I called Medtronic they were on it. They called me back soon after explaining that it was still pending but that if it comes to it, they will fight for the coverage because they have proof that my insurance agreed to it. Still have to wait and see if the insurance company is going to go through with denying me, hopefully it won’t come to that.
Thank you for your reply.
I did start with medtronic, they were great about helping me. They don’t know why the insurance company would agree to the coverage and then suddenly try to drop it after only 6 months, but they said it’s still pending. They did tell me that they have all the paperwork and phone calls with my insurance company on record, all of which prove that they did in fact agree to cover me. So they will submit those should there be another issue.
It is a horribly stressful thing to happen, I was glad to have a place to come to get some guidance.
Oh yes, I’ve had bad lows at night, quite a few were recorded when I was just starting the pump. So I do have that as proof as well.
Though I’m struggling with keeping good numbers, it seems on shots I was always dropping low so my A1c was great. Now without the lows and the few highs mixed in, my A1c has risen which is frustrating and could give the impression that I did better on shots. When in truth I was in a much more dangerous situation then.
I just wish everyone had what they needed to be as healthy and cared for as possible without all the bullying and worry that comes from this system.
thanks for replying as always, I appreciate it!
Thank you for the reply.
I’ve done my best to keep good records of our conversations. Thankfully Medtronic has all of the correspondence with my insurance company on file and even taped verbal consent to full pump coverage. So that is reassuring despite still not knowing whether or not my insurance is going to drop me.
I hope so too.
that’s so stressful, and it can’t help your blood sugar at all. In this instance Minimed seems to the be good guy, they are doing everything they can and have offered a ton of support. Hopefully it will be straightened out soon. The wait is a pain.