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Great West Nightmare

Discussion in 'Insurance Issues' started by Jfoxsmom, Mar 4, 2008.

  1. Jfoxsmom

    Jfoxsmom Approved members

    Joined:
    Mar 3, 2008
    Messages:
    6
    Hello all ....

    Am brand new to the site..and am looking for some guidance. My son Jamieson was diagnosed back in October 06, at the time we were on KY State health insurance, and a few months down the road were looking forward to getting on the pump. Just as we were getting everything in order my hubby was hired to a new company and a new insurance company...Great West. All the information from the State Insurance was forwarded onto Edge Park and Great West..(mind you this took place in July/Aug 07 and the State Insurance was prepared to get the pump.) At that point everything kinda went haywire...We were denied the pump from Great West because his c-peptide level was normal.

    At this point after many calls to our primary care provider, who I have great faith in..(if not his office staff -who refuses to return my calls), am at a loss as to what to do now..Do we need to retest his c-peptides..??..

    I know the insurance company is playing the "game" but I am just sick of it. The medtronic folks I had originally talked to have all but vanished after assuring me they would help out in any/all appeals...

    Do I need to camp out at my doctors office until he gets on the phone and makes the next level of appeals? My son in the meantime is going thru puberty...so his monitor levels look like a roller coaster ride...from 40's to 300's etc..etc.. depending on the day/time and activity level.
    He is athletic and wants to play baseball and football again..(he played last year just after he was diagnosed.) but all these spikes are wearing on me. Is it me or is this is just plain nuts.:confused:
     
  2. SaltyAndSweet

    SaltyAndSweet Approved members

    Joined:
    Mar 4, 2008
    Messages:
    13
    Seems to be a trend!

    It sounds like you and I are in the exact same boat.

    I have Cystic Fibrosis Related Diabetes. It is not type 1 and it is not type 2, but I still need intensive insulin therapy. As a result of CFRD, I have normal C-peptide levels.

    I too have GreatWest Healthcare. I am trying to get a Minimed insulin pump as well, through Edgepark. GreatWest has denied coverage initially, and also my first appeal has been denied. Because of normal C-peptide levels! (the similarities between our stories is a little eerie!). I am in the "information collection" stage right now before my second and final appeal. If I have any info that may be relevant to your fight with the wonderful GreatWest, I would love to share it with you. Please send me an email. saltyandsweet65@yahoo.com

    I can easily say I share your frustration! (I have been fighting since mid December '07)
     
  3. Jfoxsmom

    Jfoxsmom Approved members

    Joined:
    Mar 3, 2008
    Messages:
    6
    Pleasure to meet you!

    Hope we can be of use to each other in this thing...Just found out from the Great West Rep what my son's initial c-peptide test result was...0.836 and that test taken right after his diagnosis in October of 06. Am wondering since he was on his "honeymoon" if that effected the initial test as well....

    Also, love your web site/blog :) have looked at it several times and got more motivated after reading what your going through...

    I am also gathering as much "ammo" as I can from the internet (nothing like mass Googling at 2am when you can't sleep...) I will be more than happy to forward any/all information to you S&S as I get it... Please feel free to email me as well at mlaura260@earthlink.net


    The other issue I am facing is that since my husbands employer is located in Texas and I am in Kentucky...which insurance laws should I focus on?

    Baby is fussy and needs a change :eek: will check back with ya all later.
     

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