Tuesday, December 29, 2009

Question!

Well, Kerri is awesome. I'm sure most of you know this but I just had to say that she is just so great. I've been having some insurance issues and she mentioned a while ago that she often gets questions from readers and if she doesn't know the answer, she'll pass them on via her blog. So I thought it couldn't hurt to ask! So I emailed her earlier today and "Voila!" within several hours she'd posted it. So, like I said, she's awesome.

To fill the rest of you in, I have been trying to go back on the pump for some time now. I used to pump in high school and college but was never in love with it and stopped in 2001. I've been on MDI's ever since and my A1C's have been good (mid-6's). I've been happy with my control and MDI's just seemed to fit my lifestyle. Early last year Brad and I decided we were very nearly ready to start a family. I talked to my Endo about it because I wanted to know what (if anything) I should be doing to prepare. He has never pushed me to go back on the pump but for pregnancy he feels it's the best option. So we decided to submit the paperwork to the insurance company and try to get me approved for the pump.

This was back in April. And I was very swiftly denied. Their words were that it was not "medically necessary" (aka my A1C's were already low "enough") and that the pump I wanted (the Omnipod) was an "out of network provider" so basically they didn't want to pay for it. Yeah, that was annoying. We have since appealed and they are standing firm with their original "No!" A couple of weeks ago, I got a called from my Endo's nurse (who handles most of the pump appeals) who suggested that we would probably have better luck if we asked for a different pump that my insurance company does have a history of approving for their patients. My second choice was the Animas Ping, so I called the Animas rep and she said that she does work with my insurance company and they have approved the Ping for some of their patients!! Yay!! So we have started the appeals process again, hoping to finally get approved. Well, here's were the problem comes in . . . no, believe it or not all that mess wasn't the "real" problem!

I'm starting a new job soon and will be changing insurance companies!! I'll be staying with my current insurance company (via Cobra) for the next 3 months or so becuase my benefits don't kick in for 90 days at the new job. But, if I actually get approved, I'll be a new pump user, so I'm not sure if it will carry over to the new insurance company?? Or will I have to go through all this appeals mess again?? I've already waited 8 months for this! And I don't really want to put the baby-making on hold any longer! ;o)

My hope is that, no matter how long I've been on the pump, whatever supplies I go into my new insurance plan using will be covered automatically without additional approval needed. But who knows? What if they don't have a contract with the pump I pick? Will they actually make me switch pumps? Can they even freaking do that? What if they don't cover pump supplies at all?

I'm stressing, can you tell? Anyway, thanks for listening to my vent and if you've already posted advice over at SUM, thanks for chiming in. If you have any other tips for dealing with insurance companies or advice from experience from this kind of thing, I'm all ears so please feel free to comment below!

Thanks all!
~Layne

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