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Pump Supplies - Durable Medical?

Discussion in 'Parents of Children with Type 1' started by ruthdmitchell, Jan 12, 2006.

  1. ruthdmitchell

    ruthdmitchell New Member

    Joined:
    Jan 11, 2006
    Messages:
    4
    Hi everyone, it's been a year or so since I've visited this forum.
    Since then, I have a new job, and new insurance. The insurance, unfortunately, is not serving us well. They are considering my daughter's pump supplies - DURABLE MEDICAL resulting in coverage of 50%.
    I know I am responsible for myself, and our lives, however, I am a single mom, and this is a real hardship. I am considering ALL options. I have spoken to my employer, the insurance company for hours on end, I have filed a complaint with the State Insurance Admin - PA - written to State Legislators, and unfortunately, seems I make to much for any sort of assistance.
    As if living with Diabetes were not enough. Does anyone have any solid advise to offer? Right at this time in my life, Overwhelmed, is putting it lightly.

    Ruth
    Mother of Rachel-9 years old- diagnosed Nov. 2003
     
  2. Sweetkidmom

    Sweetkidmom Approved members

    Joined:
    Nov 7, 2005
    Messages:
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    I don't know that I can help much, but I am also a single mom and really feel for you!

    It seems to me that one avenue to work on would be to try and get the medical insurance to reclassify the pump supplies. I don't see how pump supplies can be anything but "Consumables" (!) How do they justify classifying them as "Durable"? Ask them to explain how a single-use item can be "durable"?

    My insurance would only pay for 50% of the initial pump purchase, but thankfully they cover 90% of the pump supplies. A once-off is managable; it's the monthly costs that wear you out.

    (I also know that grey area where you earn too little to really be on top of things financially, but you earn "too much" to qualify for any assistance - grrrr!)

    Best of luck!
    Kay
     
  3. selketine

    selketine Approved members

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    I belong to a local diabetes discussion board for the Washington DC area and one of our members (lives in California now but used to live here) has often offered to help out people with insurance issues. Her husband is a lawyer and seems dedicated to helping out people in your circumstances. I sent her a message and I'm posting this here. I'm not sure how to get the two of you together! LOL! Both this forum and that block email addresses. I sent her my email address - and I'll send my email address to you and perhaps I can forward your messages to each other until you can communicate directly.

    Would this help?

    Carol G.
     
  4. Beach bum

    Beach bum Approved members

    Joined:
    Nov 17, 2005
    Messages:
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    Pump supplies

    Hi, I'm sorry to hear about your trouble getting low cost supplies. Have you tried the Healthy Kids program in your state? I know they help uninsured kids, but they might be able to help you out too. I think it's crazy that they consider a piece of equipment that lasts 2-3 days durable goods! Good luck.
     
  5. selketine

    selketine Approved members

    Joined:
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    6,057
    The person I mentioned in my previous post (Lahle) joined the forum here and has tried to post but hasn't been able. She emailed me the text of what she tried to post so I hope it helps! The following is from her:

    I am sorry that you are having trouble with your insurance company covering your diabetes care supplies. In most states, this is illegal. Insurance companies do not have to cover some items, like numbing cream for changing a canual site, batteries for the pump, etc. But they are required to cover the cartridges and canula sets.

    Many states also require covering all testing equipment. While some insurance companies try and mandate how many test strips will be covered per day (in VA, Anthem tries to get away with only cover literally one test strip per day) your doctor should be able to decide how often you need to test; not the insurance company. But you may have to fight them to get the necessary quantity covered.

    I founded www.isletsofhope.com (and IPump.org) because I have diabetes, and am also the mother of a child with diabetes (on the pump) to help others. Consider me a watchdog for those with diabetes (I go after schools that discriminate, insurance companies, and expose "cure" snake oil companies).

    You can write to an appellate attorney specializing in health insurance coverage issues (for free) through our "Ask the Lawyer" feature on the website (write to JIE@IsletsofHope.com). The site also features insurance (state and federal law) information, as well as health insurance information.

    I checked PA laws from a link on the Islets of Hope site and from what I read your supplies are required to be covered according to state law (but please do, ask our lawyer, he would know for sure):

    http://www.legis.state.pa.us/WU01/LI/BI/BT/1997/0/HB0656P2505.HTM

    For anyone reading this, just so you know whic states have enacted diabetes health insurance laws, they are:

    States that have enacted diabetes coverage laws: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

    Please, feel free to write to me at Lahle@isletsofhope if there is anything I can do to help.

    Good luck!

    Lahle
     
  6. ruthdmitchell

    ruthdmitchell New Member

    Joined:
    Jan 11, 2006
    Messages:
    4
    Pump Supplies - Durable Medical

    I agree and am aware of what you are saying, However, the insurance company considers itself "in compliance" by COVERING 50%. They are "covering" the suppl;ies, just at the possible lowest level.

    I really think that some how, I have to have this addressed and changed.
    I am not eligible for state help, I have tried everything.

    I have already been through the test strip ordeal, now this.
    What next?
     

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