Triwest military health care denies Insulet supplies and pump to diabetics

GiGiB
By GiGiB Latest Reply 2009-10-24 10:13:53 -0500
Started 2009-10-10 11:59:07 -0500

My husband is active military, and we are under Military health care – Tricare. In 2008 we were transferred to California covered by Tricare West, which is when my problems began.

I am a type 1 diabetic and have been for 37 years. Prior to getting the pump in 2007 - approved by Tricare North - I had diabetic retinopathy which left me partially blind in one eye. I have kidney damage. I take medication for high blood pressure. The Insulet Omni pod pump has allowed me to maintain excellent blood sugar control and to lower my A1C from 8.9 to 4.2.

Since transferring to Tricare West, Paul S. Molchan, the Medical Director, has once before denied me my pump supplies, stating that the supplies were not necessary for my diabetes. After one month of stressful fighting to get my pump supplies, I finally succeeded.

Just one week ago, prior to my next 3-month supply order, Mr. Molchan, again denied my pump supplies. I learned that he decided in June 2009 that the Insulet Omni pod pump was a “luxury item” and could be used ONLY for special case gestational diabetics (pregnancy). This decision is unique to Tricare West since according to the Insulet company, Tricare North and Tricare South continue to approve the Omni pod pump and its supplies.

Despite a telephone appeal to Mr. Molchan on Friday October 9 from my primary care doctor, the request for re-instating my pump supplies was not approved citing a regulation that standard products preferred. However, diabetes is a chronic disease that can cause death. This denial for pump supplies has meant that I now must begin the fight anew.

Since I already have the Insulet pump and only need the supplies, the purchase of another pump and training classes will cost the US government at least $6,000, a waste of taxpayer’s money. Furthermore, the Insulet pump has successfully allowed me to be in the best of health ever, saving the US government money. Any adjustment to something new will affect my health and blood sugar levels .

To further complicate this situation, Tricare West has erroneously listed the supply clerk at Insulet Company as my physician. So, I am now fighting to have this error corrected, but no one will take action or even return my phone calls at the Tricare West Enrollment Division.

As a result of this, I am seeking an investigation into Tricare West and Paul S. Molchan, the Medical Director, This decision is not only irrational and irresponsible but it affects ONLY those diabetics using the Insulet insulin pump covered by Tricare West. No diabetic, especially military, should have to undergo this type of stress just to stay alive.


23 replies

GiGiB
GiGiB 2009-10-23 11:52:50 -0500 Report

Hello! I wanted to give an update on my progress. It looks like the policy is being rewritten at TriWest. I am now getting word that TriWest will cover OmniPod and its supplies! It just goes to show…never settle for second best AND, don't listen to the people who tell you that it cant be done or why bother?

Crashnot
Crashnot 2009-10-23 14:35:46 -0500 Report

Can we nominate you for the determined and stubborn award? :-)

GiGiB
GiGiB 2009-10-23 14:46:34 -0500 Report

I will gladly take that :0)

Judimar
Judimar 2009-10-24 04:54:03 -0500 Report

GiGiB,

I am so thrilled to hear this news! Thank you so much for your determination, tenacity, and courage. I am sure you helped make a lot of other people's lives easier!

/cheers!

Judi

GiGiB
GiGiB 2009-10-24 10:13:53 -0500 Report

Thank you Judi!! I have been trying to get the word out to the small group of people that contacted me for help. I am helping another lady who has Blue Cross. Thank you for being so supportive!

GiGi

Judimar
Judimar 2009-10-15 01:13:35 -0500 Report

I don't blame you for fighting it. Work your way up the chain of command. Insurance companies are NOT doctors…GAH this just makes me so angry…

I am sorry you have to go through this. Please keep me posted. I hope you get some help and your supplies.

*hugs*

Judi

GiGiB
GiGiB 2009-10-15 10:40:00 -0500 Report

Hi Judy,
I am actually making progress! I have two Congress members who are part of the Diabetic Caucus that will help and not to mention a few other political people I have managed to get in touch with. One of liasons for Triwest has told me my case has already infiltrated their office and people are scambling! This is the first good news I have had since I started fighting this. I have a lot people who tell me I can't acoomplish anything by this…just wait! It is our right to speak out and our duty. I am hoping this change will happen for all the diabetics stationed out here, not just me! Thank you so much for your support Judi, it means alot!

GiGi

Crashnot
Crashnot 2009-10-15 11:20:42 -0500 Report

You go girl! We're with you! And this is a marvelous precendent to get more insurance companies to shape up!

GiGiB
GiGiB 2009-10-15 12:39:06 -0500 Report

Thank you! I will keep you posted on what is going on. I am also hanging on to all my contacts in case someone needs help. Thank you so much for the positive response. Our society is way too compliant about issues! Let's keep in touch!

GiGi

Judimar
Judimar 2009-10-15 17:13:50 -0500 Report

NP GiGi! I was an army brat and I saw my mom struggle to get her diabetic syringes and alcohol wipes back in the 80's. She was told since my dad was retired they wouldn't help her at all. She fought her way through the chain of command and the insurance company and got them to comply. I know it will be tough and frustration but you are definitely worth it!

*hugs*

Judi

GiGiB
GiGiB 2009-10-15 23:51:35 -0500 Report

Hi Judi!
Good for your mom fighting that battle and winning! Hoo rah! I wish more people would stand up and say "no we arent going to accept this". I am going my way through the chain as well and being careful it doesnt fall on my husband (I check w/him first). My parents taught me to fight for what I beleived in and I am. So glad to hear from you again!
Hugs!
GiGi :0)

Crashnot
Crashnot 2009-10-16 11:52:48 -0500 Report

Lord knows, few military personell get paid what they're worth, you better get your money's worth for helping the troops be all they can be!

Sarguillo
Sarguillo 2009-10-14 16:57:52 -0500 Report

Does Triwest have a parent corporation? One that oversees the others? If so, try appealing to them.
Good luck

GiGiB
GiGiB 2009-10-14 21:12:22 -0500 Report

Hi. Actually it is Tricare and then it get broken down in to regions as the military is all over our country: west is Triwest, North is Tricare north etc etc. I am almost ready to submit my appeal and I have a Congress member on my side. Too many people tell me I can do this but I can!! thanks for your response.

Harlen
Harlen 2009-10-13 20:04:52 -0500 Report

I know why they are doing it
even if you are able to go the three day
and only use 10 a month thats 480.00 a month with the other pumps its like 180.00 a month over a year thats 4600.00 a year in expence over the other pumps
they get the pump for a low price as well so that may be why they are doing it
I wish you the best
Harlen

2catty
2catty 2009-10-14 17:38:47 -0500 Report

Harlen you are right. They are the cheapest pumps to get and start-up but they become the most expensive to buy the supplies for. That is why insurance companies don't like them. Plus alot of them say they have to many pod failures. I have the animas ping and love it. But I don't blame you for fighting to keep what you like. It should be your call.

GiGiB
GiGiB 2009-10-14 21:10:51 -0500 Report

Hello
Thanks for the responses. It helps a lot and I am fighting this and have made some good progress. FYI - if there is a pod failure, Omni pod replaces it. but like any other company if you place it in a bad area - its your own fault :0(. I will keep you posted and again thank you!

GiGiB
GiGiB 2009-10-14 21:13:40 -0500 Report

Hi Harlan
This was helpful. None of us on the omnipod insulin pump even received any notice this was happening so a lot of us were left with less than a two week supply. What is even worse, triwest wont give any guidelines on what pumps are acceptable.

Harlen
Harlen 2009-10-10 20:59:29 -0500 Report

I wish you the best luck ever
The inscomp are there to make money not help us
I have the medtronic 722 and I love it
they my just not like paying so much for the supplies I know my comp will not pay for other pumps or supplies
I hope things go better for you soon
one pump is like other pumps so schools not hard carbs are carbs
sorry for your pain and stress

daniel velazco
daniel velazco 2009-10-10 20:44:03 -0500 Report

I have been out of the military for over
35 years, but I wounder if you can get your supplies from the base hospital. I
don't know how this works anymore. DAN

GiGiB
GiGiB 2009-10-14 21:15:34 -0500 Report

Hi dan
no, unfortuantely i cant. I need to go to the company to get it. what is disheartening is that people tell me to just accept it. I will not and will do my best to change this. I have never seen such compliancy in people. thanks for your post.