I wear an insulin pump and was working with my physician to acquire a device that would monitor my blood glucose levels continuously. He stated that I would need to receive training in the use of the devise before writing a letter of medical necessity to the insurance company as this was usually required by them for their approval. He then made an appointment for me with the diabetes education program offered by the hospital which employs him. Since I am on a fixed income and, on the advice of the diabetes education staff, I called my insurance company to verify that they covered this training. Their response was that they did not and that it was not needed for approval. I conveyed this to my physician whose response was that "he" required it even if the insurance company did not. I told him that the device manufacturer provided training free of charge and he replied that "it was not as good." I am wondering if he is not abusing his position by refusing me a device that would improve my quality of life unless I am trained by his employer at a cost to me when training is available free of charge from the manufacturer of the device.

Whether we think it is ethical, is not going to do you any good. No, I don't think it is ethical and ignorant on his part to limit your choices if he knows you are on a fixed income. Yes he is abusing his position, and in the past I have found that some doctors do.

Now what will your course of action be ?

Tick

He most likely has an arrangement with them, doctors recommend one medical supply house over another, one of my past jobs was just that, calling on doctors every day and talking them into sending patients to our store, not another store for canes, walkers, wheel chairs and more.

First, let me commend you for taking matters in your own hands and clarifying with the insurance company yourself. Most people are not as proactive as yourself. :)

I work in Oncology and we have similar cases with chemotherapy pumps that work similar to insulin pumps. Your doctor is correct to say that a letter of medical necessity. Even for chemo pumps, this is frequently the case.

He crossed the line by saying you should have "his" training vs. the pump company. He probably believes its better, but that being said, its probably very similar to the company's free training.

The difference is, he can charge you for an extended office visit if you come into his office to learn.

I suggest calling the office and asking for the "Office Manager". He or she may be much more willing to hear what you have to say and you'll probably be able to get the pump without the training they want you to go to. Don't be afraid to tell him/her that you are unhappy with your doctor's position on this matter... its possible they could train you and "wave" the bill from your insurance company.

It's a long shot, but don't be afraid to try. They won't get paid much for your teaching visit anyway (Aprox $45). Its much more lucritive for them to keep you happy... and coming back to their office. ;)

Good luck to you!