Here’s the deal - my doc agreed that I could benefit from a pump. She completed the certificate of medical necessity and sent it off to Liberty, the supplier my insurance (Federal BCBS) works with. The certificate of medical necessity lists me as T1, notes that I take more than 3 injections per day, and indicates that test 6-8 times per day. To my knowledge, no other paperwork was sent over (i.e., no bloodwork or anything). However, she had some question as to whether I would be covered because of how picky the insurance companies can be with pump approval.
So, Liberty is basically saying that it’s pretty definite that I will be approved based on their experience, although of course they cannot say that for certain. However, they cannot file a claim for the pump until they mail the pump and all associated supplies out to me. BCBS will not “pre-authorize” and they won’t pay a claim until the pump is delivered to me.
I signed a statement from Liberty saying that I am going to keep the pump in its box (sealed) until we know for certain that Federal BCBS is going to pay this claim. If I break the seal and the insurance doesn’t cover it, I am liable for the whole cost of the pump.
Has anyone been through this? If so, what was your experience? Did BCBS ask for additional information? Or did they pay the claim with just the certificate of medical necessity? How long did paying the claim take?
I was told to call back each week to see if the claim had been paid, and Liberty is going to see if they can expedite the claim so that I can get started on training. In the meantime, I have to hold on to an $8000 piece of medical equipment and be liable for it, which makes me really nervous. Why do they make you go through all of this?!?!?! Wouldn’t it be easier to just approve it first and then mail it out??!
And, of course, my BSLs have been horrible today. Haven’t had one reading under 160, been taking insulin and have hardly eaten anything. Grumble, grumble…probably all the stress from being on the darn phone for 2 hours with Liberty and insurance.