- advertisement -

Personal letter to insurance for pump and CGMS appeal

Discussion in 'Insurance Issues' started by SaltyAndSweet, May 5, 2008.

  1. SaltyAndSweet

    SaltyAndSweet Approved members

    Joined:
    Mar 4, 2008
    Messages:
    13
    Hi all!
    I need some advice. I am writing a letter to my insurance company for my final appeal with getting an insulin pump and continuous glucose monitor (Minimed). I am at a total loss as to what to say and what not to say.

    My background: Insurance is denying coverage because I have a normal c-peptide and no antibodies. I have Cystic Fibrosis related Diabetes which is not Type 1 or Type 2, but I take Lantus and Humalog, sometimes up to 8 shots a day because of my insane nutrition needs (super high calorie). I eat almost continuously. I am having a hard time controlling my bg levels because of it. High bgs causes complications with my CF, mainly due to dehydration. I have been denied coverage twice now (primarily because of the c-peptides and lack of antibodies) and only have one chance left.

    My case manager suggested I add a personal letter to the reviewer for more impact and to show I have a genuine interest in getting the equipment. What on earth do I say in this letter?
    Thanks for your help! :)
     
  2. GaPeach

    GaPeach Approved members

    Joined:
    Dec 29, 2007
    Messages:
    2,218
    Is your doctor and/or pump rep helping out at all?

    I would think that you have a medically compelling reason CF to have this approved. Perhaps the problem is that your insurance company has not dealt with this combination before (CF & D).

    See if the pump rep can advise you on approval avenues.
     
  3. SaltyAndSweet

    SaltyAndSweet Approved members

    Joined:
    Mar 4, 2008
    Messages:
    13
    Thanks for the advice. Yes, my doctor has helped a TON. She has spent many many hours working on my appeal. I think the pump rep has helped her too (along with several other doctors, a lawyer, and a few other people). My doc has completely amazed me in how much she has put towards helping me. I know a lot of doctors would have given up a long time ago. :) I feel so lucky!

    I felt necessary to write a personal letter about my case in hopes it is one more "piece of evidence" that I really want/need this pump and CGMS. Even though I am a blog writer, I get writer's block quite often, especially in times of stress like this. Somehow I was able to find some inspiration and got a really good letter written. Overall, my doc has sent in 14 pages and has asked to talk personally to the people reviewing my case. I really hope this time the reviewers will be a little more forgiving and even though I don't have "Type 1" (which is who the policy only allows pumps for) maybe they will allow an exception.

    The problem is partially that my insurance has not dealt with anyone with CF and CF related Diabetes (and refuses to become educated about it), and partially because they are super frugal (who can blame them, they are in business for money, not for healthcare!)

    Here's a link to my letter for anyone interested:
    Final Appeal - Personal Letter

    Thanks again for your advice! :)
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice