Hi Chele (& board!),
My son will be four tomorrow, and is scheduled to begin insulin pump therapy for his insulin-dependent diabetes. He has a wonderful, wonderufl doctor, and until now, we've had no problems with his HMO. However, the pump that we want for him isn't covered by his HMO
even though it is the same cost to the hospital! They
only contract with the major pump company. The pump we want is geared to those with smaller insulin needs (like kids). Given that the costs to the HMO are exactly the same, why wouldn't they cover the one with the theraputic edge?
I'm just questioning all these things after talking to reps at the pump companies, their insurance departments, our HMO AND their durable medical equipment departments. I've even consulted a disability rights organization, because this just reeks of "monopoly/anti-trust" scrtach my back, I'll scratch yours big corporate politicking.
The company we want to go with sees little hope of winning any appeal for denial of coverage, but they are willing to go 110% to back me & help in any way they can, including presentations to our endo team.
I know that by questioning the "status quo", I'm doing what is best for my son...I guess I just needed the reassurance this board would provide me. Being that we have to pay for 20% of this device, I want it to be the one that best meets the unique needs my small son has. And because it is theraputically better, I guess I just don't get why the HMO wouldn't be on board with that. And both would cost our family the same, so it's not a cost-cutter for us either...it's just the same cost across the board, but with an added benefit to my son.
If anyone has dealt with this, I'd love to hear your story. Or if there are other organizations that you feel could help me with this, I'd be grateful for your input.
Thanks!
Warmly,
Marie <img src="/images/graemlins/smile.gif" alt="" />
Attachment Parenting Host
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