Discussion in 'Insurance Issues' started by momtojess, Jan 28, 2008.
deleting all threads, too much cwd drama
no problem within 30, or even 60 days... but her AGE could be a problem
If you sit quiet past 90 days some insurance Co's will make you start over (completely). But a few weeks for preparing your documentation won't be a problem, I think.
But you're maybe gonna have a special difficulty with Jess: she's not 7 years old yet. That's a possible problem area, MM CGMS is currently approved only children 7 and older (Dexcom is approved only for adults). So there could be a battle of words about "she's already competent to manage her own pumping, and there's no magical physical difference between long-standing IDDM-T1 at age 6 and long-standing IDDM-T1 on her 7th birthday. The medical necessity is already present, and she clearly demonstrates the capabilities of a "typical" pumping 7-year old to manage her diabetes."
Every time you appeal you have to get better information.
Maybe we should all start taking our kids to the ER every time they sneeze. I think the insurance companies would take note a little more quickly if we hit them where it hurts. They cannot deny ER visits. :cwds:
THe problem with that is unless we get admitted it will cost us $250. 00 per er visit.. Not counting drive: 45 minutes away and maybe having hubby take off of work to help watch my 3 year old then.
They cannot deny er visits but they can still make them hurt.
I think you noticed, even the first draft of our appeal letter includes the specific FDA web address for the approval pdf's. Our second draft will also provide a number of journal articles Per my PM, please mail me a xerox of the entire letter, and we'll put together the 2nd draft to pass around next week-- and maybe also post here for comments.
Other smart CWD members are watching, and can probably suggest further improvement for that draft before we send it.
Separate names with a comma.