Thursday, March 15, 2007

Help, I need somebody; Help, not just anybody......

Excuse me a moment whilst I flip the bird to my insurance company.

I need some insulin pump supplies and a visit to my endo. They say they are being nice to me because they have waived my usual 18-month waiting period for coverage to only 8 months. I suppose this is a gift, but I'm sorry, this is a bunch of bullshit. It's bad enough to make me swear on my blog posts! I'd use an even worse word, but there might be 13-year-olds reading this somewhere.

Me: I can't even get reimbursed?
Customer Service Lady: Ma'am, we can't reimburse you for something you don't have coverage for.
Me: Well, this is something that's never happened to me before. I can't afford these things without insurance. Isn't there anything you can do?
CS Lady: There's nothing, Ma'am. You could go to your doctor for whatever paperwork you might need, but they're just going to show you have the pre-ex condition, and we can't cover any pre-exes until your waiting period is over.

This is just so damn awesome. I can't believe how lucky I am to live in this country with the greatest healthcare in the free world. AAAAAAAAAARGH.

But maybe there is some light in this situation after all.

My co-worker informs me that HIPAA guidelines state that it's illegal to deny me coverage for ANY period of time as long as my coverage previously didn't lapse. (And it didn't!) My co-worker knows her way around health insurance...she is a cancer survivor.

Tomorrow I'm having a chat with the HR lady, hoping she can help me straighten this stuff out once and for freakin' all.

What kind of crap has your insurance company tried to pull on you?

***
In slightly related news, the nurse educator from my endo's office is my new hero for the week. I explain my problem to her last week, and she gave me an entire box of sample infusion sets. I had been using Sof-Sets at home, but she only had Quick-Sets for the Paradigm (or Silhouettes, but I was kind of worried about the angled-needle thing). She let me borrow an insertion device and I'm on my second Quick-Set. I really like them. I might switch to them permanently once I can figure out what I'm covered under.

Any opinions on infusion sets?

8 comments:

  1. Definitely talk to your HR person, but if you haven't had a break in any health insurance coverage, the insurance company is supposed to waive any pre-existing condition issues.

    And personally, I've used Silhouettes for more than six years and have never had a reason to try anything else. The long needle looks scary, but once you can insert it without a problme, you won't look at it in the same way again.

    Good luck--I've often fought with insurance company and typically get what I need.

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  2. I have not had problems with Insurance thank God I just have crappy doctors.

    I use the Quick Sets and I love them. Although they are the only ones I have ever tried but I like them so far.

    I hope things work out. If HR person doesn't help, get an email and we will Spam Bomb her email box! (the geeky revenge!) ;)

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  3. Re: Infusion sets - I exclusively used Silhouettes when I was with Minimed, I now use Comfort sets (Cozmo's comparable set). Love this type of set. The long needle isn't that intimidating - and insertion is a snap - I guess I like the control I get, as opposed to using an injector thing that just puts it in... Plus, they stay in without any problem at all.

    Look at the below - if you didn't have a gap in coverage - you shouldn't have a waiting period - by law. Definitely talk to your HR person.

    From an HR website I've looked at:

    HIPAA regs specify content of preexisting condition exclusion notice (January 31, 2005)

    Issue: You are aware of the recently issued final regulations governing the portability requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). What do the regulations now require for a general notice of preexisting condition exclusion?

    Answer: The regulations, which become effective on February 28, 2005 and apply for plan years beginning on or after July 1, 2005, indicate that a general notice of preexisting condition exclusion must include:
    the existence and terms of the plan's preexisting condition exclusion, including:
    the length of the plan's look-back period;
    the maximum preexisting condition exclusion period under the plan; and
    how the plan will reduce the maximum preexisting condition exclusion period by creditable coverage;
    a description of the rights of individuals to demonstrate creditable coverage, and satisfaction of any applicable waiting periods, through a certificate of creditable coverage or through other means; and
    a person to contact (including an address or telephone number) for obtaining additional information or assistance regarding the preexisting condition exclusion.
    Plans can use the following sample language as a basis for preparing their own notices to satisfy the requirements in the final HIPAA regulations:

    This plan imposes a preexisting condition exclusion. This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within a six-month period. Generally, this six-month period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the six-month period ends on the day before the waiting period begins. The preexisting condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 30 days after birth, adoption, or placement for adoption.

    This exclusion may last up to 12 months (18 months if you are a late enrollee) from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior “creditable coverage.” Most prior health coverage is creditable coverage and can be used to reduce the preexisting condition exclusion if you have not experienced a break in coverage of at least 63 days. To reduce the 12-month (or 18-month) exclusion period by your creditable coverage, you should give us a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, we will help you obtain one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating creditable coverage.

    All questions about the preexisting condition exclusion and creditable coverage should be directed to Individual B at Address M or Telephone Number N.

    Source: 69 FR 78719, December 30, 2004.

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  4. Lyrecha--I'm beginning to think my insurance company screwed something up and thinks either (A) my coverage lapsed or (B) I have private and not group insurance. Both of those things are wrong. Grrr. When I started pumping, they started me on Sof-sets, and I couldn't imagine anything without an insertion device. Also, I thought I read somewhere that angled needles aren't that great if you're overweight (like me, especially my midsection where my sets always go!)...I could be wrong though.

    George--I think our spam bomb should contain a bunch of ads for diabetes "cures". Maybe she'll get the point. Noni Juice, anyone? The big advantage to the Quick Sets is the tape is already attached. I took a long shower this morning and that lil' sucker hasn't budged! It's great!

    Nicole--Thanks for the HR reading material. I will print it out if it's necessary! :)

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  5. Do you need supplies? If so, I have a TON of silhouettes and reservoirs that I'd be happy to send you.

    I hope you get it sorted out. That really sucks. The worst that's happened to us is that O was denied the test strips her doctor ordered and I spent six weeks fighting with the insurance company about it. They kept "losing" the paperwork.

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  6. Stories like yours are why I have yet to work for an insurance company as an RN- that kind of thing would royally annoy me and I'm not good about keeping my mouth shut when it comes to diabetes. I have used Sof-sets since I went on the pump-let me know if you want me to send you a box to get you through. I have tried a silhoette and Quick Set but I'm not a fan of change when something is working. And the Sof-sets work best for me.

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  7. What a frustrating situation.

    I hope you get things straightened out, but if you need anything you know you can turn to us!

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  8. Mollie1:47 AM

    i can only use the minimed quick set, and i love it! the inserter is great too. :)

    i've tried the silhouhette, but it just freaks me out each time i try or even look at them. lol. and i'm not afriad of needles either. i dont know what it is with the silhouhette.

    goodluck though!
    talk to you later..

    btw, i'm adding you my blog roll. :)

    Happy St. Patricks Day!! :)

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