Anyone ever have this problem?

[funnygrl]

I asked this in the adults with type 1 section too, but I figure I'll get more or a response here.

I got my pump in July. I filled out all of the paper work accurately. My pump was approved and shipped to me and I've been using it.

It's been 6 months, almost, and now I got a letter from my insurance saying that they have changed their mind, they are no longer paying, and I'm responsible for the cost.

I can't afford this. What am I suppose to do?

Can they do that?

My dad is threatening to hire a lawyer.

[Mom2rh]

If they gave you approval and the pump was shipped based on that, I'd assume they would have to honor that.

Good luck...I hope it doesn't come to hiring a lawyer because that could get expensive. I would think the pump company would make them pay...and they could afford the lawyers better than you guys. I'm thinking that is the best tactic. Let the pump company fight it out.

[Ivan's Mum]

I know here we have an insurance and savings ombudsmen - do you have anything thing like that that governs these companies and they have to abide by the ombudsmens decision?

In general insurance terms, they can't change your policy without your permission. I would assume that someone has their wires x-ed.

Before you kick butt, dig a little deaper in to the story before you hit them with both guns.

[Charmed7]

I don't know the answer, but document document document. Keep all letters they send, get names times and numbers of everyone you talk to. They will be doing the same thing, so keep all that information in case it does turn into something.

I would definitely ask the pump company for their documentation with the approval. I don't think they can go back and make you pay for the pump. They may have a right to say they won't cover future supplies. Then you could appeal that and go from there.

Good luck,

Charmed

[clb1968]

My insurnace sent me a letter stating that I was covered for the pump itself, there was a certain time that I had to get the pump in, they gave me 30 days on it. Then I got another letter that showed that they were covering a year on the supplies and I will have to get approval in a year for them.

I hope you can get it figured out.

[wilf]

I asked this in the adults with type 1 section too, but I figure I'll get more or a response here.

I got my pump in July. I filled out all of the paper work accurately. My pump was approved and shipped to me and I've been using it.

It's been 6 months, almost, and now I got a letter from my insurance saying that they have changed their mind, they are no longer paying, and I'm responsible for the cost.

I can't afford this. What am I suppose to do?

Can they do that?

My dad is threatening to hire a lawyer.

I would go public with this - get it in the papers, on tv, on-line.. By the way, what is the name of the insurance company? Start giving them serious grief! Get your local politicians involved. And the Diabetes Association..

[thebestnest5]

Grrrrr how awful.:mad:

I would never wish Type 1 on anyone; but this makes me kinda wish that the powers-that-be in that insurance company could experience life with Type 1 for a short while and actually see that a pump should not be treated like it's a luxury.

[kel4han]

What was the denial reason? Maybe I missed it in the posts.......I can probably help you. I have been working in Medical Insurance claims for 12 years, send me a PM if you need.

[funnygrl]

The reason for the denial was that this is my second pump. "Replacement of a properly functioning insulin pump is considered not medically necessary; including, but not limited to, when the pump: had exceeded the warranty time period. According to notes submitted by your doctor, the pump you are currently using is out of warranty."

The thing is, I made sure they knew I already had a pump. Minimed has separate paper work for current pump wearers that I filled out.

And they decided my Minilink is medically necessary as well, which I cannot use without the pump.

[payam7777777]

bast***s..........

[Armyemily]

I asked this in the adults with type 1 section too, but I figure I'll get more or a response here.

I got my pump in July. I filled out all of the paper work accurately. My pump was approved and shipped to me and I've been using it.

It's been 6 months, almost, and now I got a letter from my insurance saying that they have changed their mind, they are no longer paying, and I'm responsible for the cost.

I can't afford this. What am I suppose to do?

Can they do that?

My dad is threatening to hire a lawyer.

You don't happen to have Tricare do you?
You need to call the pump company have them mail you the approval they recieved from the insurance company and then fax that to the insuance company. Also you should request and caseworker from you insurance company. That way one person is only working on your case.

[funnygrl]

Nope I don't have Tricare (and thank God based on the stories I've heard about them).

I talked to Medtronic today. They told me my insurance has paid them and they have no evidence from them that they plan on doing otherwise :confused:

So they told me if/when they get a denial letter from insurance they have the name of the rep and the date that told them that I was covered for a replacement pump. They said they'll appeal on my behalf and this shouldn't be an issue, so I don't really need to worry about it.

Phew.

[Kaylee's Mommy]

if they've already paid minimed (which I'm assuming mm got before they even shipped it out..) then you have nothing to worry about, they can NOT make you pay for something that they've already said was covered AND paid for.. future supplies may be different.. but if they were covering them before then they should still be covering them..

I thought it was standard to get a new pump every 4 years when your warrenty was up.. but come to think of it, I've never checked on that with our insurance company.. hmm..

Glad MM will do the fighting for you if it comes to that!