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.
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