Questions for Canadian Pumpers concerning insurance

I think you should contact your HR department -- They're supposed to know exactly what your plan
covers and should be able to verse you on any changes to the plan.

In the US, such changes would usually have been originated by your employer, not the insurance
company, and they would have been required to notify you of the changes in coverage. Any reduction
in coverage would only happen at the plan renewal and the employee gets to decide if he wants to
continue participation.

I'll be curious to know how it works in Canada.

--
T2 - HbA1c: 5.4%
bollar.orgdiabetes.htmOpen ↗

"Vicki Beausoleil" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I'm despondent. I feel like I've been screwed over something fierce. I
don't know what to do next. I think I'm going to contact the Human
Resources dept. of hub's company and [censored] at them. At the very least I
can get an up-to-date coverage booklet.

Vicki,

if you're going to use minimed, contact their insurance relations dept. they have some good ppl in
there. i'm not canadian, can't help ya there with how your system works. i know from reading the IP
(insulin-pumpers) list there are some canadians there that have pumps. perhaps join and ask them for
a bit of advice as well.

other then that, MM does have a payment plan if you purchase one out right.

good luck, best thing I ever did.

rk

"Vicki Beausoleil" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I've been fighting my insurance company for almost seven months trying to get an insulin pump.

I've been told by group member information people the pump was covered 100% as a necessary medical
device, I was told the pump would be covered 100% as a once-in-a-lifetime expense. I've been told
that it would be covered at 80% same as prescriptions, and also told 70%. After applying, I was
told the pump wasn't covered at all but the consumables were covered at 80% or 70% (they've told
me both and it's supposed to be 80%)

I was turned down because it wasn't deemed medically necessary (that's a load of ...). After re-
applying, I was told it wasn't covered under my plan.

I'm despondent. I feel like I've been screwed over something fierce. I don't know what to do next.
I think I'm going to contact the Human Resources dept. of hub's company and [censored] at them. At the
very least I can get an up-to-date coverage booklet.

Our coverage used to be through Clarica, which was taken over by SunLife while my claim was being
considered. There has been changes to our plan, and we were never notified. Our prescription
coverage was 80% - but now the insurance company talks about coverage for consumables etc. at 70%.
The last bunch of prescriptions I had refilled I noticed the coverage was only 76% instead of 80.
I think these [censored] at SunLife are trying to reduce our coverage without our knowledge.

Does anyone have any experience with something like this? Do I have any recourse? We have what is
called a basic plan and we won't be able to change to an 'enhanced' plan until Jan. '05. I don't
even know if it'll make a difference, and I certainly don't trust SunLife to tell me the truth,
they haven't so far.

I did use the service that is supposed to take care of all the insurance issues. It's called
Medicum and is based in Montreal. Out of sheer curiosity, who pays these people?

Does anyone have a pump they want to sell to me? (kidding - sort of)

I'm now testing at least 10 times a day. I'm gonna be sure to get every bloody expensive brand-
name drug my endo wants to give me. One way or another, these aholes at SunLife are gonna pay...

Any advice or experience anyone could give me would be greatly appreciated. I really don't know
what to do next.

Vicki vickiatmaildotnetroverdotcom is valid.

test

--
Steve Type 1 DM since 1967 MiniMed 508 since early 2002 Toronto, ON Canada

"Vicki Beausoleil" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I've been fighting my insurance company for almost seven months trying to get an insulin pump.

I've been told by group member information people the pump was covered 100% as a necessary medical
device, I was told the pump would be covered 100% as a once-in-a-lifetime expense. I've been told
that it would be covered at 80% same as prescriptions, and also told 70%. After applying, I was
told the pump wasn't covered at all but the consumables were covered at 80% or 70% (they've told
me both and it's supposed to be 80%)

I was turned down because it wasn't deemed medically necessary (that's a load of ...). After re-
applying, I was told it wasn't covered under my plan.

I'm despondent. I feel like I've been screwed over something fierce. I don't know what to do next.
I think I'm going to contact the Human Resources dept. of hub's company and [censored] at them. At the
very least I can get an up-to-date coverage booklet.

Our coverage used to be through Clarica, which was taken over by SunLife while my claim was being
considered. There has been changes to our plan, and we were never notified. Our prescription
coverage was 80% - but now the insurance company talks about coverage for consumables etc. at 70%.
The last bunch of prescriptions I had refilled I noticed the coverage was only 76% instead of 80.
I think these [censored] at SunLife are trying to reduce our coverage without our knowledge.

Does anyone have any experience with something like this? Do I have any recourse? We have what is
called a basic plan and we won't be able to change to an 'enhanced' plan until Jan. '05. I don't
even know if it'll make a difference, and I certainly don't trust SunLife to tell me the truth,
they haven't so far.

I did use the service that is supposed to take care of all the insurance issues. It's called
Medicum and is based in Montreal. Out of sheer curiosity, who pays these people?

Does anyone have a pump they want to sell to me? (kidding - sort of)

I'm now testing at least 10 times a day. I'm gonna be sure to get every bloody expensive brand-
name drug my endo wants to give me. One way or another, these aholes at SunLife are gonna pay...

Any advice or experience anyone could give me would be greatly appreciated. I really don't know
what to do next.

Vicki vickiatmaildotnetroverdotcom is valid.

RK said:

Vicki,

if you're going to use minimed, contact their insurance relations dept. they have some good ppl in
there. i'm not canadian, can't help ya there with how your system works. i know from reading the
IP (insulin-pumpers) list there are some canadians there that have pumps. perhaps join and ask
them for a bit of advice as well.

other then that, MM does have a payment plan if you purchase one out right.

good luck, best thing I ever did.

rk

"Vicki Beausoleil" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I've been fighting my insurance company for almost seven months trying to get an insulin pump.

Thanks for your responses. I'm going to get in touch with HR at hub's work and let them know
what's going on (I'm waiting for hub to get me the #). I feel something is really rotten here,
and I want some satisfaction. It rots my socks that I was told on three occasions it was covered,
then told seven months later it wasn't. The woman at Medicum told me that SunLife is a very
difficult insurance company for them to deal with, and I can see why. They can't even get their
stories straight.

Vicki

20 Oct 2003 08:59:33 -0400 said:

Thanks for your responses. I'm going to get in touch with HR at hub's work and let them know
what's going on (I'm waiting for hub to get me the #). I feel something is really rotten here, and
I want some satisfaction. It rots my socks that I was told on three occasions it was covered, then
told seven months later it wasn't. The woman at Medicum told me that SunLife is a very difficult
insurance company for them to deal with, and I can see why. They can't even get their stories
straight.

i went thru a similar thing in mid-'92 when my miserable MM504 failed and the replacement failed
within a day (2 failures in 3 days)

because my lousy MM504 was only 18 months old i found myself fighting a "coverage" battle with the
insurance company for roughly 4 or 5 months and it simply wasn't worth it (bigtime aggravation with
small minded medical people; yes, my complaint was reviewed by *medical* people)

you need one thing first: a letter of medical necessity from your doc. without that you are nowhere

if your doc won't do that, get a doc who will (ask the pump rep for a ref to a doc in your area who
is in favor of pumps)

in my case the problem was that i was pushing for 100% coverage. given what i now know about my
basal needs, the MM504 was in fact a totally inadequate pump *for* *me* but i did not know enough
then to be able to prove it for the review by the medical people

once i took the attitude that i might have to pay a small percentage (i think it turned out to be
30%), i let the pump rep handle it and it was worry free

anyhow, once you have the letter of medical necessity, give a copy to the MM rep (or the rep of
whichever pump you are interested in) and let them handle it. you may well have to pay a sizeable
percentage (30% or more), but that's better than paying all of it

the pump reps know what to do and will be able to tell you if any of it is covered

good luck, bill

p.s. MM is the #1 company in the USA and probably Canada too, and from what i've seen posted here on
m.h.d., their current 508 pump and Paradigm pumps are excellent

willbill said:

20 Oct 2003 08:59:33 -0400 said:

Thanks for your responses. I'm going to get in touch with HR at hub's work and let them know
what's going on (I'm waiting for hub to get me the #). I feel something is really rotten here,
and I want some satisfaction. It rots my socks that I was told on three occasions it was
covered, then told seven months later it wasn't. The woman at Medicum told me that SunLife is a
very difficult insurance company for them to deal with, and I can see why. They can't even get
their stories straight.

i went thru a similar thing in mid-'92 when my miserable MM504 failed and the replacement failed
within a day (2 failures in 3 days)

because my lousy MM504 was only 18 months old i found myself fighting a "coverage" battle with the
insurance company for roughly 4 or 5 months and it simply wasn't worth it (bigtime aggravation
with small minded medical people; yes, my complaint was reviewed by *medical* people)

you need one thing first: a letter of medical necessity from your doc. without that you
are nowhere

if your doc won't do that, get a doc who will (ask the pump rep for a ref to a doc in your area
who is in favor of pumps)

in my case the problem was that i was pushing for 100% coverage. given what i now know about my
basal needs, the MM504 was in fact a totally inadequate pump *for* *me* but i did not know enough
then to be able to prove it for the review by the medical people

once i took the attitude that i might have to pay a small percentage (i think it turned out to be
30%), i let the pump rep handle it and it was worry free

anyhow, once you have the letter of medical necessity, give a copy to the MM rep (or the rep of
whichever pump you are interested in) and let them handle it. you may well have to pay a sizeable
percentage (30% or more), but that's better than paying all of it

the pump reps know what to do and will be able to tell you if any of it is covered

good luck, bill

p.s. MM is the #1 company in the USA and probably Canada too, and from what i've seen posted here
on m.h.d., their current 508 pump and Paradigm pumps are excellent

Thanks, Bill

All the paperwork was in place for the application. The service I used (Medicum) handled all the
stuff with my endo.

My endo has pushing for me to pump since it was confirmed I'm T1 3 1/2 years ago. Safety issues with
my job was the reason I didn't apply before. The possibility of dropping a six thousand dollar
medical device into a fryer full of hot fat was too scary and the physicality of the job made
wearing anything on my person potentially dangerous. Now that we use frozen product the job is much
safer and less physically demanding.

The first application was rejected because it was deemed 'medically unnecessary'. My endo wrote a
scathing reply to the insurance company with the second application and it was very strongly worded
;-). It was then rejected as 'not covered by my plan'. This is the part that frustrates me the most.
They didn't even bother to tell me, they told Medicum.

This isn't over, not by a long shot. Hub has one of those flexible plans, so at the next opportunity
we will upgrade to the enhanced plan and apply again, but that won't be until Jan. '05. That's the
worst case scenario.

Thanks again,

Vicki

Good Luck Vicki We had the same problem with the pump not being covered under "our" plan. We were
never able to get coverage for it or the pump supplies but decided to go ahead with it anyway for
our daughter. It has helped give her back her health and some childhood freedom. After our daughter
started pumping I designed a pump pouch for her to wear that would work for her varied activities &
sports, she even sleeps with her pump pouch on. Take a look at it at
execulink.compouches.htmOpen ↗ it may be helpful for you to wear at work (she tucks any
extra tubing in the pouch with her pump so that it doesn't accidentally get caught on anything).

Heather execulink.comdiabetictag.htmlOpen ↗ execulink.compouches.htmOpen ↗

Quoted message said:

All the paperwork was in place for the application. The service I used (Medicum) handled all the
stuff with my endo.

My endo has pushing for me to pump since it was confirmed I'm T1 3 1/2 years ago. Safety issues
with my job was the reason I didn't apply before. The possibility of dropping a six thousand
dollar medical device into a fryer full of hot fat was too scary and the physicality of the job
made wearing anything on my person potentially dangerous. Now that we use frozen product the job
is much safer and less physically demanding.

The first application was rejected because it was deemed 'medically unnecessary'. My endo wrote a
scathing reply to the insurance company with the second application and it was very strongly
worded ;-). It was then rejected as 'not covered by my plan'. This is the part that frustrates me
the most. They didn't even bother to tell me, they told Medicum.

This isn't over, not by a long shot. Hub has one of those flexible plans, so at the next
opportunity we will upgrade to the enhanced plan and apply again, but that won't be until Jan.
'05. That's the worst case scenario.

Thanks again,

Vicki