What is this supposed to mean?!

[Cinnabon]

Listen to this...

I hounded my insurance this entire week regarding my pump since it has been 2 weeks exactly since I submitted my medical necessity letters. The referral department tells me to give them 48 to 72 hours. After 72 hours, I begin to call. Today, 4 calls later,they tell me to let their supervisor come in, its 11:45 am already (odd). By 4 pm, no call, I make the final attempt. Another rep talks to me and tells me I had been DENIED!!! & this denial had come in 3 days after I my original submission. Not only had they not informed me, She really had no answers for me, and this definitely doesn't make sense.

I was devastated! Only answer they could give me was "IT WAS NOT COVERED". I decide to call Humana directly. I have Humana w/ Medicaid and deal with a medical center in between. I asked for a clear explanation of this DENIAL after they had clearly informed me that It was covered but just needed a "Medical Necessity" letter. He says........but it is APPROVED and gave me the approval #. I call my medical center back, inform the rep of this, and ask what is going on here???. She simply verified my home # and had no explanation & just tagged it as "how weird". I made sure I told her how devastated I was when she gave me her news.

Now, what can I make of this because I sure don't plan to keep quiet and they are closed for the weekend. Right away I called a medical equipment company, faxed them over everything including the "INFAMOUS" approval #. What would you think???? :mad:

[duck]

My first job out of college was at a call center for BCBS...Now I am going to be very insulting, but keep in mind I was working for the call center that contracted out to BCBS:

The call center staff were all very young: I was about the oldest at 23. Only a handful of us had college degrees, and we were getting paid ****, not even the country average in pay, and this is in the Metro DC area, an expensive area to live. And if we were a sad bunch, the claims department was sadder (I joke all the time: "Do you know how claims people in insurance claims got their job? It was a promotion because they cleaned the toilets the best in their previous job..."). So basically, when you call in to a insurance call center, keep in mind the people are probably under-educated, under-paid and unhappy with their job--They probably JUST got their butt reemed by the previous caller before you, and you are one of 100 calls they will take today.

Now, having said that, there are always those that do a good job, and now their stuff. In general, call centers get 90% of the information they dole out correctly. But that 10% can be bad. Always get bad news IN WRITING--you can guarantee that insurance will not put incorrect info in writing.

[camjen1]

Oh yes this can be explained very easily, it's your insurance giving you the run around. :rolleyes:

Surely you had to see it coming, I do believe it is stated in the itsy bitsy black print in your handbook.

Cheer Up!!! I got a not covered letter in the very beginning but yet I was never denied. Hmmmm don't know.

[Cinnabon]

Did you get it and it was bad info from the middleman?

[camjen1]

It was directly from my insurance company. I called them right away and they said that it is approved but....... I can't really remeber what they said because it was intended for someone who can understand their lingo. If you do get flat out denied then I would talk to the endo and have him do some magic powers.

[Cinnabon]

Its really confusing , they give me an Approval #.. Im wondering if this medical center that stands in the middle of it is real ignorant or just want to cause confusion. My Insurance just told me straight out, your pump was approved and began to give medical suppliers info.

[camjen1]

Make sure you hold on to that # because if after all is said and done and you are denied then throw that # in their faces. Ask them so what is this huh huh, how did I get an approval # huh huh. Then you ask when should I expect my pump?

[Cinnabon]

Im just about to tattoo that lil # right where the sun don't shy, in case they need to see it for verification purposes!! (LOL)

[CarlyesHope]

Im just about to tattoo that lil # right where the sun don't shy, in case they need to see it for verification purposes!! (LOL)


Funny, thats where i keep all of our medical record numbers too....

[daddyo]

Cinnabon are you working with a pump Co, If so give them the aproval # and they will take it from there, Like I've stated before, I was denied for over 1 1/2 years before I was approved, but once I got the approval it only took a week to get my pump, And yes I am also on medicaid, and also the first to get a pump from the insurance Co. that I signed up with. Total Health Care. they have been great since.

[Cinnabon]

Thank you DaddyO,

As soon as I got that approval #, which I didn't expect, I started calling different pump companies and faxing them over all the info. It was just real weird to me that all of a sudden, the medical group (middleman) comes up w/ a denial and then my insurance 2 minutes later tells me that I was approved.

[Belinda]

Stick to your guns...so to speak...make sure you write down the date, time and the NAME of each rep you talked to when your taking down information. It always helps to have this.

[daddyo]

Yeah I got my approval out of tghe blue, I was about to give up tring when they called and said I was approved. Like I say never give up.

[Cinnabon]

Ok.... I just got a message on my cell phone from Humana, my insurance rep. stating "You are approved for your insulin pump, but they want you to work with one specific medical company " and he left me their info. to call them.
Now, it seems kind of odd to me, apart form this whole issue, that on Friday afternoon, when I got the ball rolling and called ALL the companies from a list given to me by my insurance. One of those companies I had called was the same one they are giving me now. This company told me Friday, they do NOT have insulin pumps.

[daddyo]

Cinnabon, Go straight to the major pump Co. they will get you started with the pump, after that you may have to deal with Co. that your insurance deals with for all your supplies, That's how I have to handle it My pump came from Mini-med but all my supplies I get from a local Co. Even though they are MM supplies, But they also don't deal with the actual pump. Good Luck Keep us posted I will give you all the help you need to get this going. Oh by the way the Pistons will beat the Heat. At least I hope so. Sorry I'm off topic on that.

[Cinnabon]

i DID TAKE YOUR ADVISE AND BEFORE i GOT THAT MESSAGE i CALLED THE MAJOR PUMP COMPANIES AND FAXED THEM ALL THE INFO. tHANKS AGAIN.

oH AND ON THAT "oFF THE TOPIC" SUBJECT.. WE WILL SEE ABOUT THAT, WE STILL GOT 1 FAME TO GO,... IN THE RED ZONE!!!!! (LOL) WATCH OUT NOW!!! :mad:

[Cinnabon]

Ok,
I need a little help here..
The medical supply company is requiring a Rx stating the type of pump and what kind of supplies.... I plan to go there now and tell him to give it to me so I can speed this up.

[duck]

What help do you need? Picking the pump?

edit--that sounds rude, I'm not trying to be, I'm asking seriously.

[Cielo]

Cinnabon,

What is the latest with this?

[Cielo]

Cinnabon,

What is the latest with this?

Sorry, ignore this....I forgot to go to Page 2 and thought that the last post on this thread was from Saturday.

[Cinnabon]

Hello there everyone,

Id like to say that I could never take anything as rude or insulting form anyone on here, except spammers! You guys have offered me nothing but support and help. This is the latest news flash on my Superfragalistic- Expialidocious - PUMP situation:


my pump was approved 3 days after submitting all my medical Necessity. letters.
I was told I was DENIED by Bubble brained reps :mad:
Medical equipment company can not release the pump till my Endo calls in and tells them what pump and all supplies needed for me.
Cinnabon has called her Endo, Primary, medical supply company, and ALL major pump companies in the US directly, as well.
Faxed them ALL information, too.


Now, I'm about to go postal, LOL. They are going to drive me to drinking!!!! This is amazing how complicated they can make it by simple lack of communication!!
I will update as the time Slowly ticks.......

[camjen1]

Well which pump company did they approve?

[twocute64001]

Congratulations on your pump approval. Please clarify a point for me - did you fax - call ALL the different pump companies or have you settled on one pump you prefer? If so, which one?

I ask because working with one company and their rep will usually speed up the process for you.

Now you are at the point that the hardest choice will be "what color do you want" (I picked blue but that purple sure is pretty)

[Cinnabon]

They need my Endo to call in the specific pump to them. I know I walked into my appointment with the Cozmo Insulin Tech system , but he should have specified that on my letter.

[Cinnabon]

Congratulations on your pump approval. Please clarify a point for me - did you fax - call ALL the different pump companies or have you settled on one pump you prefer? If so, which one?
I ask because working with one company and their rep will usually speed up the process for you.
Now you are at the point that the hardest choice will be "what color do you want" (I picked blue but that purple sure is pretty)

Thank you... I still don't want to get too excited, its just they have put me on the worst roller coaster ride for NO reason. I initially walked in to my appointment w/ the Cozmo Insulin Tech system in mind. I just want it to be as easy as possible, maybe the Minimed. See I have to deal w/ Medicaid and there is a medical center in the middle. I took my chances with that approval # and began to contact as many companies as possible, just emailing them not faxing them. Stating my situation, Cozmo was the first to reply by phone offering help. They love to fight this battle, lol. I will keep you updated....

BTW, Blue or purple might be my favorites.. LOL ;)

[Cinnabon]

Oh by the way the Pistons will beat the Heat. At least I hope so. Sorry I'm off topic on that.

Ok, Ok.....

Hands down.. My blood sugar is still elevated after watching my MIAMI HURT Team play last night..... :(

[daddyo]

Ok, Ok.....

Hands down.. My blood sugar is still elevated after watching my MIAMI HURT Team play last night..... :(


Hey D-Wade was great. my hats off to him he looked like he was in alot of pain, But the Pistons are a great closing team when push comes to shove.Sorry to hear about your sugers though, Hope that pump comes through, made a differance in my life. From the problems you describe, it sounds like Medicaid is diffrent state to state. Good Luck, hang in there, :) and never give up.

[Cinnabon]

Ok...
Here the deal all...
The medical supply that will be issuing my pump needs to know the specific pump I need and only my Endo can do that, unfortunately they do not work directly w/ the pump co. :mad: I hope I can choose a color if it applies....