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Question:

From California, USA:

I have an eleven year old with Type 1 diabetes. He is currently taking three or four shots a day depending on blood sugar. His control is quite good. His last HA1c was 7. My question is how do you convince HMO's to approve something. My son is very interested in the pump as he is getting sick of shots and dealing with low blood sugars. He wants a pump, but the HMO company is saying that as long as he is in good control with getting his 3-4 shots a day, they don't see a point in it. My problem is that I have noticed in the past month that he is starting to get discouraged with having to take so many shots and I hate for him to become lazy about his diabetes. Any suggestions? I know that I am going to be fighting an uphill battle. I think that they should think about the patient before they think about price.

Answer:

Unfortunately it is hard to convince an HMO to spend money on something for convenience of the patient. Usually you have to come up with a reason to justify the "medical necessity" of the expense. By any chance is your son having a lot of lows during the night? If so, you might be able to convince the HMO that the pump is medically necessary as it will be more effective preventing severe nighttime lows which can lead to seizures.

TGL

[Editor's comment: Both Disetronic and MiniMed are experienced with working with insurance companies and can help your son's doctor write a letter of medical necessity. JSH]

Original posting 27 Feb 1999
Posted to Insulin Pumps and Social Issues: Insurance/Costs

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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