This appeal has been a bane on me for months. It has consumed me for the last two weeks. But it is done, and I can now go back to spending more time on finishing the WP site.
It took about 40 pages and another 40 pages of enclosures.
Many thanks to @Eric, who gave me lots of material to use, inspired me with whole sections, and painstakingly reviewed two different drafts.
I hope you get good news soon!!!
What was the rationale for requiring an appeal? Was it just wanting a non-preferred brand, or are they saying you shouldn’t have a pump?
Insurer is UHC. They bounce any pump request unless it is Medtronic. They have an exclusive agreement with Medtronic – however unbelievable this sounds. It is supposed to be for adults 18 and above, but they appear to apply blanket refusals to everyone.
[EDIT] Clarification: they do not disagree with a pump, only with a pump that is not Medtronic.
Yeah, that was what I was afraid of when I saw the news on that agreement getting signed. Having worked for many years for the big M, I am saddened but not surprised that they would pursue a deal like that.
I hope your appeal is successful.
That is just crazy that any insurance would effectively create an Monopoly (I’m sure they’re getting gratuities or kick-backs from Medtronics) with your childs’ medical health. Every insurance should allow the parents/patients in consult with their medical professionals, to choose the best pump that fits their lifestyle.
I’ve never heard of such an insane stance for an Insurer to take! Hope they approve this. Is this your only option for insurance carriers?
I am sure 
Yes Through work.
In the business they are referred to as rebates, which is legal, while kick-backs are not. We will see more of this. Interestingly, Kaiser, who we currently have, is notorious for going single vendor, yet we have the choice of 3 brands within their system.
This is so sad…such a major overhaul is needed for Pharma and Health Insurance Providers…but this doesn’t seem to be a priority in our nation. Until that happens, our healthcare will always be overpriced, and provide inadequate care for the cost required.
@Michel I think you’ll get it Michel. UHC has buckled under less.
Last year they denied my Dexcom in January. I leaned on them over the phone, sent in a couple of written appeals and by my next Dexcom order in April they relented.
Good Luck!
How in heaven could/would they deny you a Dexcom?
You should also write an 80 page letter to Medtronic begging the to make a pump that belongs in this century!
Good luck I hope the appeal works out for you!
Might be even tougher than the appeal 
@Michel I was taking Jardiance, so they deduced that I was T2, and denied on that basis. Morons.
This was despite my diagnosis code from my endo being T1.
Completely ridiculous.
Are you pretty much stuck with UHC?
Yes.
May 2016 News Release
“Medtronic to Become UnitedHealthcare’s Preferred DME Provider of Insulin Pumps for Diabetes, Effective July 1, 2016”
[yeah - I know. old news. But I am kinda going somewhere.]
United Health Care Network Bulletin: May 2016
Just prior to this evil backroom deal being cooked up and served cold to an unsuspecting population, [really no bias here - just the facts 
], Medtronic had a stock price that had been slowly rising over the long years and seemed to have plateaued in the upper $70’s. After the initial exuberance of trading investors thinking this was going to be the new golden goose appeared to have worn off and Medtronic came to the realization that too much business is sometimes a bad thing [for instance when you have not enough product to deliver - hey - anybody remember the artificial shortage of the cabbage patch dolls so as to create demand from nothing - but totally unrelated to this situation] the stock price of Medtronic appears to have again plateaued in the upper $70’s.
