Insurance denied coverage again

[SaltyAndSweet]

I am right behind you Lindsey by about a year. I was diagnosed with CFRD in 2000 and have been taking shots since then.

I'll know the exact details of this second denial probably tomorrow when I receive the letter. The case manager read it to me over the phone, but I just couldn't write fast enough to take good notes.

From what I have scribbled down, I meet the criteria for intense insulin therapy, and my A1C is greater than 7%, but my c-peptide test was normal. It sounded like the "independent reviewer" of my appeal was not all that familiar with CFRD and claims it is more like Type 2, insulin resistant, diabetes and that I shouldn't need the extra bolus of insulin for my meals.

(-sarcastic comment warning-) I am wondering if the independent reviewer believes that I am overweight (5'5" 107lbs) and should control my Type 2 diabetes by dieting.

 

[SaltyAndSweet]

I am right behind you Lindsey by about a year. I was diagnosed with CFRD in 2000 and have been taking shots since then.

I'll know the exact details of this second denial probably tomorrow when I receive the letter. The case manager read it to me over the phone, but I just couldn't write fast enough to take good notes.

From what I have scribbled down, I meet the criteria for intense insulin therapy, and my A1C is greater than 7%, but my c-peptide test was normal. It sounded like the "independent reviewer" of my appeal was not all that familiar with CFRD and claims it is more like Type 2, insulin resistant, diabetes and that I shouldn't need the extra bolus of insulin for my meals.

(-sarcastic comment warning-) I am wondering if the independent reviewer believes that I am overweight (5'5" 107lbs) and should control my Type 2 diabetes by dieting.

 

[SaltyAndSweet]

I am right behind you Lindsey by about a year. I was diagnosed with CFRD in 2000 and have been taking shots since then.

I'll know the exact details of this second denial probably tomorrow when I receive the letter. The case manager read it to me over the phone, but I just couldn't write fast enough to take good notes.

From what I have scribbled down, I meet the criteria for intense insulin therapy, and my A1C is greater than 7%, but my c-peptide test was normal. It sounded like the "independent reviewer" of my appeal was not all that familiar with CFRD and claims it is more like Type 2, insulin resistant, diabetes and that I shouldn't need the extra bolus of insulin for my meals.

(-sarcastic comment warning-) I am wondering if the independent reviewer believes that I am overweight (5'5" 107lbs) and should control my Type 2 diabetes by dieting.

 

[SaltyAndSweet]

I am right behind you Lindsey by about a year. I was diagnosed with CFRD in 2000 and have been taking shots since then.

I'll know the exact details of this second denial probably tomorrow when I receive the letter. The case manager read it to me over the phone, but I just couldn't write fast enough to take good notes.

From what I have scribbled down, I meet the criteria for intense insulin therapy, and my A1C is greater than 7%, but my c-peptide test was normal. It sounded like the "independent reviewer" of my appeal was not all that familiar with CFRD and claims it is more like Type 2, insulin resistant, diabetes and that I shouldn't need the extra bolus of insulin for my meals.

(-sarcastic comment warning-) I am wondering if the independent reviewer believes that I am overweight (5'5" 107lbs) and should control my Type 2 diabetes by dieting.

 

[SaltyAndSweet]

I am right behind you Lindsey by about a year. I was diagnosed with CFRD in 2000 and have been taking shots since then.

I'll know the exact details of this second denial probably tomorrow when I receive the letter. The case manager read it to me over the phone, but I just couldn't write fast enough to take good notes.

From what I have scribbled down, I meet the criteria for intense insulin therapy, and my A1C is greater than 7%, but my c-peptide test was normal. It sounded like the "independent reviewer" of my appeal was not all that familiar with CFRD and claims it is more like Type 2, insulin resistant, diabetes and that I shouldn't need the extra bolus of insulin for my meals.

(-sarcastic comment warning-) I am wondering if the independent reviewer believes that I am overweight (5'5" 107lbs) and should control my Type 2 diabetes by dieting.

 

[coltsfan715]

I am so sorry that you are having such issues with this. I hate that truly.

I am not seeing the endocrinologist that started me out on my insulin pump currently to ask him how he got this covered for me - I am set up through my transplant center for diabetes care right now. I do know though that my docs classified me s Type 1 I think. Though yes it is CFRD being that I am insulin dependant they have just typed it as type 1 for records and such.

Good Luck,
Lindsey

and as for your sarcastic comment I understand what you mean. I was in the hospital post transplant and being that I am diabetic they automatically put me on a restricted diet. I would try and get more food and they would tell me my diet was restricted for diabetes purposes. Post transplant I weighed about 105 - I am 5'7". I was so freaking hungry one day that when the woman told me that I said "How about you come up to my room and tell me that I need to be on a weight restricted diet! - Give me some freaking food!" She stammered and apologized and I had my snack within 30 minutes lol. People just get so used to the stereotypical diabetes that they fail to see exceptions.

Take Care

 

[coltsfan715]

I am so sorry that you are having such issues with this. I hate that truly.

I am not seeing the endocrinologist that started me out on my insulin pump currently to ask him how he got this covered for me - I am set up through my transplant center for diabetes care right now. I do know though that my docs classified me s Type 1 I think. Though yes it is CFRD being that I am insulin dependant they have just typed it as type 1 for records and such.

Good Luck,
Lindsey

and as for your sarcastic comment I understand what you mean. I was in the hospital post transplant and being that I am diabetic they automatically put me on a restricted diet. I would try and get more food and they would tell me my diet was restricted for diabetes purposes. Post transplant I weighed about 105 - I am 5'7". I was so freaking hungry one day that when the woman told me that I said "How about you come up to my room and tell me that I need to be on a weight restricted diet! - Give me some freaking food!" She stammered and apologized and I had my snack within 30 minutes lol. People just get so used to the stereotypical diabetes that they fail to see exceptions.

Take Care

 

[coltsfan715]

I am so sorry that you are having such issues with this. I hate that truly.

I am not seeing the endocrinologist that started me out on my insulin pump currently to ask him how he got this covered for me - I am set up through my transplant center for diabetes care right now. I do know though that my docs classified me s Type 1 I think. Though yes it is CFRD being that I am insulin dependant they have just typed it as type 1 for records and such.

Good Luck,
Lindsey

and as for your sarcastic comment I understand what you mean. I was in the hospital post transplant and being that I am diabetic they automatically put me on a restricted diet. I would try and get more food and they would tell me my diet was restricted for diabetes purposes. Post transplant I weighed about 105 - I am 5'7". I was so freaking hungry one day that when the woman told me that I said "How about you come up to my room and tell me that I need to be on a weight restricted diet! - Give me some freaking food!" She stammered and apologized and I had my snack within 30 minutes lol. People just get so used to the stereotypical diabetes that they fail to see exceptions.

Take Care

 

[coltsfan715]

I am so sorry that you are having such issues with this. I hate that truly.

I am not seeing the endocrinologist that started me out on my insulin pump currently to ask him how he got this covered for me - I am set up through my transplant center for diabetes care right now. I do know though that my docs classified me s Type 1 I think. Though yes it is CFRD being that I am insulin dependant they have just typed it as type 1 for records and such.

Good Luck,
Lindsey

and as for your sarcastic comment I understand what you mean. I was in the hospital post transplant and being that I am diabetic they automatically put me on a restricted diet. I would try and get more food and they would tell me my diet was restricted for diabetes purposes. Post transplant I weighed about 105 - I am 5'7". I was so freaking hungry one day that when the woman told me that I said "How about you come up to my room and tell me that I need to be on a weight restricted diet! - Give me some freaking food!" She stammered and apologized and I had my snack within 30 minutes lol. People just get so used to the stereotypical diabetes that they fail to see exceptions.

Take Care

 

[coltsfan715]

I am so sorry that you are having such issues with this. I hate that truly.

I am not seeing the endocrinologist that started me out on my insulin pump currently to ask him how he got this covered for me - I am set up through my transplant center for diabetes care right now. I do know though that my docs classified me s Type 1 I think. Though yes it is CFRD being that I am insulin dependant they have just typed it as type 1 for records and such.

Good Luck,
Lindsey

and as for your sarcastic comment I understand what you mean. I was in the hospital post transplant and being that I am diabetic they automatically put me on a restricted diet. I would try and get more food and they would tell me my diet was restricted for diabetes purposes. Post transplant I weighed about 105 - I am 5'7". I was so freaking hungry one day that when the woman told me that I said "How about you come up to my room and tell me that I need to be on a weight restricted diet! - Give me some freaking food!" She stammered and apologized and I had my snack within 30 minutes lol. People just get so used to the stereotypical diabetes that they fail to see exceptions.

Take Care

 

[blindhearted]

I was gonna suggest that you get a Case Manager within the insurance company that is assigned to you, but it sounds like you have one. All the ones I ever had would help the person get what they needed by doing the internal work (talking to the appeal board, explain why it is needed, etc). I don't have an insulin pump but that is how I upgraded my vest, the doctor said they have never heard of a PPO agree to a vest upgrade. I would keep trying. Maybe your doctor can send in information about CFRD as well as a letter of medical nesscessity. Good luck.

 

[blindhearted]

I was gonna suggest that you get a Case Manager within the insurance company that is assigned to you, but it sounds like you have one. All the ones I ever had would help the person get what they needed by doing the internal work (talking to the appeal board, explain why it is needed, etc). I don't have an insulin pump but that is how I upgraded my vest, the doctor said they have never heard of a PPO agree to a vest upgrade. I would keep trying. Maybe your doctor can send in information about CFRD as well as a letter of medical nesscessity. Good luck.

 

[blindhearted]

I was gonna suggest that you get a Case Manager within the insurance company that is assigned to you, but it sounds like you have one. All the ones I ever had would help the person get what they needed by doing the internal work (talking to the appeal board, explain why it is needed, etc). I don't have an insulin pump but that is how I upgraded my vest, the doctor said they have never heard of a PPO agree to a vest upgrade. I would keep trying. Maybe your doctor can send in information about CFRD as well as a letter of medical nesscessity. Good luck.

 

[blindhearted]

I was gonna suggest that you get a Case Manager within the insurance company that is assigned to you, but it sounds like you have one. All the ones I ever had would help the person get what they needed by doing the internal work (talking to the appeal board, explain why it is needed, etc). I don't have an insulin pump but that is how I upgraded my vest, the doctor said they have never heard of a PPO agree to a vest upgrade. I would keep trying. Maybe your doctor can send in information about CFRD as well as a letter of medical nesscessity. Good luck.

 

[blindhearted]

I was gonna suggest that you get a Case Manager within the insurance company that is assigned to you, but it sounds like you have one. All the ones I ever had would help the person get what they needed by doing the internal work (talking to the appeal board, explain why it is needed, etc). I don't have an insulin pump but that is how I upgraded my vest, the doctor said they have never heard of a PPO agree to a vest upgrade. I would keep trying. Maybe your doctor can send in information about CFRD as well as a letter of medical nesscessity. Good luck.

 

[Sevenstars]

I think Lindsey's idea might be the best way to get it approved. Just have your doctor "lie" and say you have type 1 diabetes. It seems like they don't understand what CFRD is anyway, and it's the only way to get what you need. I'm sorry you're having such problems getting this approved, especially taking that many shots - it seems ridiculous.

Incidentally, when I go into the hospital and they take my medical history I don't even tell them I have CFRD. I know if I do, they'll stick me on the diabetes diet.. then I have to kill everyone on the floor. <img src="i/expressions/face-icon-small-tongue.gif" border="0"> If someone does notice "hey, her old chart says she has CFRD" I make ABSOLUTELY sure that the resident/on call doc puts me on a "High Calorie" diet so they don't even think about putting me on a restricted one.

Good luck getting your pump covered, I'm sorry I don't have more advice for you. As a last resort - perhaps your social worker or nurse can physically call the insurance and talk to them. It's much harder to deny something over the phone than stamping DENIED on a form. Again, good luck.

 

[Sevenstars]

I think Lindsey's idea might be the best way to get it approved. Just have your doctor "lie" and say you have type 1 diabetes. It seems like they don't understand what CFRD is anyway, and it's the only way to get what you need. I'm sorry you're having such problems getting this approved, especially taking that many shots - it seems ridiculous.

Incidentally, when I go into the hospital and they take my medical history I don't even tell them I have CFRD. I know if I do, they'll stick me on the diabetes diet.. then I have to kill everyone on the floor. <img src="i/expressions/face-icon-small-tongue.gif" border="0"> If someone does notice "hey, her old chart says she has CFRD" I make ABSOLUTELY sure that the resident/on call doc puts me on a "High Calorie" diet so they don't even think about putting me on a restricted one.

Good luck getting your pump covered, I'm sorry I don't have more advice for you. As a last resort - perhaps your social worker or nurse can physically call the insurance and talk to them. It's much harder to deny something over the phone than stamping DENIED on a form. Again, good luck.

 

[Sevenstars]

I think Lindsey's idea might be the best way to get it approved. Just have your doctor "lie" and say you have type 1 diabetes. It seems like they don't understand what CFRD is anyway, and it's the only way to get what you need. I'm sorry you're having such problems getting this approved, especially taking that many shots - it seems ridiculous.

Incidentally, when I go into the hospital and they take my medical history I don't even tell them I have CFRD. I know if I do, they'll stick me on the diabetes diet.. then I have to kill everyone on the floor. <img src="i/expressions/face-icon-small-tongue.gif" border="0"> If someone does notice "hey, her old chart says she has CFRD" I make ABSOLUTELY sure that the resident/on call doc puts me on a "High Calorie" diet so they don't even think about putting me on a restricted one.

Good luck getting your pump covered, I'm sorry I don't have more advice for you. As a last resort - perhaps your social worker or nurse can physically call the insurance and talk to them. It's much harder to deny something over the phone than stamping DENIED on a form. Again, good luck.

 

[Sevenstars]

I think Lindsey's idea might be the best way to get it approved. Just have your doctor "lie" and say you have type 1 diabetes. It seems like they don't understand what CFRD is anyway, and it's the only way to get what you need. I'm sorry you're having such problems getting this approved, especially taking that many shots - it seems ridiculous.

Incidentally, when I go into the hospital and they take my medical history I don't even tell them I have CFRD. I know if I do, they'll stick me on the diabetes diet.. then I have to kill everyone on the floor. <img src="i/expressions/face-icon-small-tongue.gif" border="0"> If someone does notice "hey, her old chart says she has CFRD" I make ABSOLUTELY sure that the resident/on call doc puts me on a "High Calorie" diet so they don't even think about putting me on a restricted one.

Good luck getting your pump covered, I'm sorry I don't have more advice for you. As a last resort - perhaps your social worker or nurse can physically call the insurance and talk to them. It's much harder to deny something over the phone than stamping DENIED on a form. Again, good luck.

 

[Sevenstars]

I think Lindsey's idea might be the best way to get it approved. Just have your doctor "lie" and say you have type 1 diabetes. It seems like they don't understand what CFRD is anyway, and it's the only way to get what you need. I'm sorry you're having such problems getting this approved, especially taking that many shots - it seems ridiculous.

Incidentally, when I go into the hospital and they take my medical history I don't even tell them I have CFRD. I know if I do, they'll stick me on the diabetes diet.. then I have to kill everyone on the floor. <img src="i/expressions/face-icon-small-tongue.gif" border="0"> If someone does notice "hey, her old chart says she has CFRD" I make ABSOLUTELY sure that the resident/on call doc puts me on a "High Calorie" diet so they don't even think about putting me on a restricted one.

Good luck getting your pump covered, I'm sorry I don't have more advice for you. As a last resort - perhaps your social worker or nurse can physically call the insurance and talk to them. It's much harder to deny something over the phone than stamping DENIED on a form. Again, good luck.