I am a diabetic in Wisconsin. I currently am on Medicaid which will cut me off in a couple of…read moremonths due to me no longer being under the age of 19. Although this insurance has covered a number of medical supplies directly related to my type 1 diabetes, it has denied both a Dexcom and an insulin pump for largely arbitrary reasoning. This will not a succinct review as this situation has been anything but simple, understandable, and bound by reason. First, the Dexcom, a device which enables users to quickly access their current glucose levels allowing for informed decisions which can be extraordinarily valuable if one's glucose is heading toward dangerous levels, was refused despite having a prescription for such a device and following the expected protocols such as regularly testing glucose at least 4 times daily. This insurance company falsely claimed that I had not been adequately testing my glucose levels, it asserted that my diabetes was "too controlled" in the sense that I had not allowed my blood sugar to fall to dangerous levels (they listed under 50 mg/dL) at least twice per month, and they asserted that my diabetes was "under controlled" as my glucose would occasionally register as "too high" -- they did not specify what levels were too high. Finally, they also claimed that the prescription would not be filled as I am under the age of 25. I would hope this goes without saying but thoroughness is to be valued. One, the age of 25 has absolutely nothing to do with controlling and living with diabetes. It is not as though before the age of 25 one cannot develop diabetes. Having quick access glucose testing is useful for any diabetic no matter if they are 80 or if they are 6. Second, although I do not have proof of if this company has received or is capable of reading the medical documentation my doctors have sent them, I have provided the records of my glucose testing prior to be refused by this company. Their claim that I was not adequately testing is simply false and, to me, constitutes a form of fraud as it misrepresents material facts for the purposes of avoiding expense -- ie monetary gain. Third, the idea that a sufferer of any disease must show that their disease has not once but twice placed their life into danger per month in order to "be worthy" of their insurance paying for legitimate, standard medicine is a sickening notion. This same idea applies to their claim that my glucose had risen too high therefore the client, or patient, is not worthy of having medical devices designed to better equip them to avoid said highs. This oversight should have been enough on its own to clearly indicate deep-rooted issues with this company, but it seems failure is not a solitary thing for Group Health Cooperative of Eau Claire. Today, I received two letters denying me an insulin pump. These devices are meant to enable those with diabetes to better control their insulin levels through inputting carbs consumed and setting insulin supply rates actively without having to carry insulin pens, needles, and sterilization tools for injection. These pumps can also communicate with tools like the Dexcom which allow for notification of low or high glucose matched with either cutting off insulin or increasing insulin. Their stated reasoning for failing to pay for legitimate, potentially life saving medical supplies prescribed by a doctor were several and wholly false. They claimed I had not sent a C-peptide test or antibody test to confirm type 1 diabetes. This is false. I had a syringe stuck into my left arm and my right arm in order to get the blood to send to the labs which then sent the data to the insurance, presumably. This insurance also claimed that my "Blood sugar logs show that blood sugars are being controlled with current insulin treatments so we would not approve a pump at this time." In case I have not been clear, the Decom refusal explicitly stated that part of my denial was because my diabetes was both too well controlled in the sense that severe hypoglycemia had not occurred at least twice a month and my diabetes was not controlled enough as it had occasionally resulted in hyperglycemia. This strongly suggests that this company both has my glucose logs and has concluded that no matter if my diabetes is controlled enough or not controlled, they will not pay for medical devices literally meant to help diabetics better manage their lifelong disease. In the other letter of refusal, they again claimed that they had not the peptide test which was completed about a month or more ago. I lack the space required to further explain the situation. In essence, Group Health Cooperative of Eau Clair has now twice failed to pay for prescribed, legitimate medical equipment on the basis of arbitrary, and occasionally materially false claims. Engaging in this kind of fraud when peoples' health is at stake is deeply disappointing. I would not recommend being ill if one has this insurance.

From the owner: Group Health Cooperative is a community-based non-profit health plan that delivers high-quality,…read morepersonalized service to its members. The Cooperative started as a local coalition over 30 years ago. While it is still a local plan with a local focus, it is now a nationally recognized HMO serving over 99,000 members in Western Wisconsin.

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