From Las Vegas, Nevada, USA:
I am 16 years old, have type 1 diabetes, and want to go on an insulin pump. Do you have any advice on dealing with an insurance company in getting one? They turned down our request because my HbA1c hasn't been consistently over 7% for the past six months.
I've had this problem too. Get your doctor to download the meter and look at the data. If your HbA1c is below 7% and you aren't having hypos, I'd be surprised. You may need to use the The Continuous Glucose Monitoring System and get three days of data. I bet the glucoses will show a lot of variability. That's reason for a pump.
Additional comments from Dr. Tessa Lebinger:Be sure to tell them if your HbA1c is so "good" because you are having too many serious low, potentially dangerous blood sugars. If you have passed out or seized, let them know. Tell them you have more trouble during sleep and need the variable basal rate to avoid both lows and highs. Do not tell them you want it for flexibility. You need to understand that their justifications may not match your reasons.
Additional comments from Dr. Stuart Brink:You should discuss this with your diabetes team. They know how to prescribe insulin pumps and whether or not you would be a good candidate. If your A1c is in good shape but you have large swings in blood glucose readings, problems with frequent or severe episodes of hypoglycemia or several other specific medical problems, they should be able to document this and write a letter of medical necessity on your behalf. If you and your team think you should be treated with an insulin pump and your insurance company refuses, you should find out about how to file an appeal so that the decision can be reconsidered.
Additional comments from David Mendosa, A Writer on the Web:Customer service representatives from the major pump manufacturers will help you with the insurance companies if they can. Contact the people at MiniMed, Disetronic, and/or Animas depending on which pump you want.
Additional comments from Dr. Donough O'Brien:I talked to our social workers about your problem, and their answer was that the insurance company would argue that a pump was a convenience rather than a necessity, and that there was no way to compel them to supply the device. Your doctor might be able to convince them otherwise.
[Editor's comment: If you haven't submitted a "letter of medical necessity" written by your doctor, get your doctor to write one. If your doctor has written one, and it has been rejected by the insurance company, appeal the decision. It can take multiple tries to get the attention of the appropriate people at the insurance company, and it can take a lot of persistence. WWQ]
Last Updated: Tuesday April 06, 2010 15:09:18
This Internet site provides information of a general nature and is designed for educational purposes only. If you have any concerns about your own health or the health of your child, you should always consult with a physician or other health care professional.
This site is published by T-1 Today, Inc. (d/b/a Children with Diabetes), a 501c3 not-for-profit organization, which is responsible for its contents. Our mission is to provide education and support to families living with type 1 diabetes.
© Children with Diabetes, Inc. 1995-2016. Comments and Feedback.