Do Doctors listen… Really?

Recently, at my last appointment in August, I was speaking with my Endocrinologist. We were discussing my insulin pump and I did point out to him that since my cataract operation, I was finding my Minimed Revel pump hard to see.

Before I had that operation, my vision was pretty bad in general, but holding something close to my face, I was able to read. My vision has always been poor, I was born about three months premature, so the oxygen in the incubator and my retinas had an argument. Through the years, the ROP has worsened a bit, costing me the use of my right eye. I am monocular now. That pretty blue peeper on my right? Yeah, it’s fake.

The display on the Minimed pump is not unlike that of a 1980’s pager. Tiny, cramped and in a small screen. I cannot see the info here without using magnification at all. To my eyes it is a screen of blurry black dots.

MM Pump screen

Imagine trying to operate this pump with two hands (Scrolling arrows on the right in the pic, ‘ACT=Enter etc….), and also using a magnifying glass/Jeweler’s Loupe to see what you are doing. Not very easy at all!

I was telling him about a new pump that just came out, called the t:slim from Tandem Diabetes. This has a big-contrast, easier to see, touch screen. Instead of scrolling your values in etc, there’s a 10-key touchpad. In my opinion, for me, this is better for accuracy and use. I was able to see it outdoors too, which is pretty decent with these screens. Another thing, being a touch screen, ONE handed operation!

tslim front

I showed my Endocrinologist pictures of the device, how I got to hold one and try it out with the Tandem Rep. I told him I will be applying for this pump, so if he gets the request for the Letter of Medical necessity, that it would be prudent to mention the eyesight issues I now have after that cataract operation. At the time, he agreed it would make sense as “A pump is something you’re having to work with everyday!”.

I had very high hopes. People seemed to agree with my claim. Some *DID* tell me it may be more difficult with my insurance, but face it, most insurance case managers and so on are actually quite nice. They do understand and do want to help. I could never, ever blame them for a decision that is made by the entities way above them.

After a few weeks, my heart sank to receive a denial from the insurance company. Their reason was that my current pump is still working and under warranty. Uh, OK, but that is not the issue!

Of course, I began to appeal this decision straight away. I wrote a ‘snail-mail’ letter to my Endocrinologist asking if they had, in fact, mentioned my visual impairment. No reply from the Endo’s office as yet. Tandem, to their credit has been in contact with me through all of this, so I have to say this is refreshing and I like being “In the loop” when discussing something like equipment for my health care.

When Tandem’s insurance verification rep called me on Thursday the 13th of Sept, I asked him about what was said in the Letter Of Medical Necessity from my Endocrinologist. The rep looked over it, reading it to me.  Nothing was mentioned about my eyesight in any of the forms sent to them or my insurance. The blood tests that were sent to them were from MAY, I’d had blood work done in August.

I had sent back the appeal forms to my insurance Wednesday, Sept 12, 2012 along with a letter I wrote to them about the eyesight. Probably a good thing I did! As nothing had been said about the visual acuity, I can’t blame the insurance for denying my claim because they did not have all the facts! I feel that had they known of the ocular issues, this may have put the claim in a completely different light. I might have been asked to visit an Ophthalmologist of their choosing, I might have been asked for more blood work, I would have been fine with this!

I really am beginning to wonder if people actually LISTEN to each other? It seems that if we see something on Twitter, or on the web, in an email, we remember it better than if we simply hear it from someone in person. I may be wrong in most ‘normal’ cases, but I feel we in the role of Patients NEED our Health Care Professionals to LISTEN. To HEAR us. If they don’t give us that much, Where does that leave us when we need their help?

In this age of technology, the insurance themselves have everything about me on file, I would think, but I guess hoping someone would actually review a case in front of them is expecting a lot. That is why I think all of us as People with diabetes, or anyone with a chronic condition must become or best advocates. WE have to take this by the neck ourselves a lot of the time.

So, appeals sent, actual, printed snail-mail letters sent, phone calls done for the weekend. I hope I have good news to report soon. I have had T1 D for 28 years and no complications from it at all. I wish you the best as well.

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7 Responses to Do Doctors listen… Really?

  1. Linda McCann says:

    Hi Jenny…while I am neither diabetic nor have any other chronic condition, I read this thoughtful blog post and agree completely! I wish you the best of luck in getting your very valid point across to the insurance company!

  2. alprunty says:

    It is sad, but most doctors do not have the time to follow through. The letters written are often done by an off site transcriptionist.

    You need to follow up with the doctor and challenge this decision. I would also call the new iPump company and ask them if they can allow you a loaner while you are fighting this. Maybe, due to your circumstances they will give you one for the publicity if you agree to let them market your story.

    • Sounds like an idea. I doubt they will loan, as I don’t have their pump, but we’ll see what may happen. I’ll let this appeal run, and work from the upcoming decision. Thanks for the idea!

  3. Tricia says:

    Jenny, you’re a trailblazer. Insurance often needs to have these decisions “challenged” in order for them to make better policies. I am glad you are willing to go through the “process” of appeal. I am standing with you, believing that you will be successful.

  4. Any luck on it yet? Following up with the insurance is like having a part-time job. Hope it works out.

    • I probably won’t hear anything for another week or two. They were gather medical records and stuff, then when CalO/Monarch gets the info, they’ll submit it all to the Medical director and THEN they’ll either approve it or deny it. If it’s denied again, I have the right to appeal again. And I will do so! 🙂

  5. Pingback: Can they READ? Another denial! | Sugar Beat

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