Got my A1C redone a few days ago, and it's down to 6.4 (from 12.4 at diagnosis in early February), so I'm really happy about that. I finally got a half unit pen a few weeks ago which has made dosing much easier as well as correcting (my ISF went from 1:50 to 1:75).. and my TDD has dropped from about 20 to 14.. which I feel gives me even more reason to get a pump.
I sent my info in to get approved for a pump about 3 to 4 weeks ago. My primary insurance (which I have thru the end of July) approved it right off the bat with no issues whatsoever. My secondary insurance, though, is absolutely dragging their butt. Has anyone had problems with UMR and insulin pump approvals? The nurse that is 'reviewing' my case will not return phone calls to me or the Animas representative who is handling the case.
What would you guys do? Should I call every day and leave a message until she calls me back? That seems excessive, but... not returning phone calls is pretty 'excessive' too, I feel..
And just as an aside... curious how the D community feels about the supreme court's decision today..
Sorry you're struggling with the insurance. The only suggestion I have is that my experience was Animas was really helpful at walking through the doctor, insurance, etc and making it happen (they do make a lot of money off each pumper!). So I would talk to your Animas rep.
A pump is a device that supplies insulin through an infusion set which is changed every couple days. It has a computer in it and you can set your I:C ratio, ISF and basals. You can have different basal rates throughout 24 hours because our needs vary. It's a way of getting away from shots and being able to take exact doses which a pen or syringe cannot do.
Technically, a pump is helpful for anyone who is on insulin, but I understand it is harder for Type 2's to get their insurance to approve it.
I would THINK if your primary insurance has approved it, they would be the ones to pay the majority of the price of it and your secondary insurance would pick up the balance. Insurance ususally follow what the primary insurance does..if they auth it, the secondary will follow. I dont think they can hold up your pump if your primary insurance has approved it. It's a coordination of benefits...the primary pays out, what is then remaining goes to the secondary. Are you sure the secondary KNOWS they are a secondary insurance and that your primary has already approved you? Im just wondering what the hold up is, I work in health insurance, and if someone with our plan has it as a secondary we coordinate benefits with their primary.
For my primary insurance, I simply called and told them I had a secondary insurance and it was with United. They basically acted like 'OK, whatever, we'll deal with it when the claim comes through.'
I didn't realize I even still had coverage thru that carrier until I thought to call and make sure of my term date (which is apparently July 31st). So then I had to jump through a bunch of hoops to get a letter of eligibility faxed from Aetna to United/UMR. I told United/UMR numerous times that they are my secondary through July 31st. AND they have my letter of eligibility. They SHOULD know about each other by now (but with the way things are going, perhaps not).
The nurse again did not return my call today. Tomorrow, I will call early and leave a message. If I do not receive a call back by early afternoon, I will try to speak to someone else at United/UMR and ask them about the coordination of benefits and will mention that my primary has approved it, etc, like you said..
Ask for a supervisor! That's what I usually do. I've never had to deal with two insurance companies, so I have no idea how that works. However, you are correct - someone should at least be calling you back. I don't think it's out of line to leave this woman one more message, letting her know that if you don't hear back by [TIME/DATE], you will be calling customer service and asking for a supervisor.
I left a message at 8:53am this morning. It's now almost 3:30. I did not say in the message that I would be contacting a supervisor, but I may try to, now. 3 messages 3 days in a row and she's not responding to me or Animas.
OMG! I called my sales rep at Animas and he got me on a conference call with my insurance company. We got ahold of the nurse (after being on hold for about 25 to 30 minutes) and she said I met the requirements for it being medically necessary. Which isn't a guarantee of payment and all that, but I got to order it today!!!!!!
That's awesome congratulations. Is the United you talk about part of United Health Care? I've heard they can be difficult, but I'm glad it has all worked out for you.
Yes, and no? The insurance is actually 'AVMAGHLIT', underwritten by New York Life and managed by UMR which I believe is a subsidiary of United. We still use the United PPO network though.
And thanks everyone!
I think the hardest decision was which color to get..
