Nicholas's last A1C was 5.5 which should have been wonderful but we wanted to get him started on the pump over the summer so when school started in the fall he would be used to it.Well we learned that unless his A1C was 7 or higher his insurance would not pay for the pump and supplies.Thats like being punished for keeping tight control! If he lets everything slide to get the pump what will this do to his body and then what will it cost the insurance company! Its not right !!!!
I just don't get that requirement of some insurance companies! Before I started pumping my A1c was always in the 5 range but I also had many severe hypos (the lind that cause you to pass out, have seizures and get visits from the paramedics) as well as a lot of high numbers. If my insurance just based approval on my A1c I never would have gotten one. I had my meter logs (from Lifescan's software) printed out that showed how crazy my numbers were on a daily basis.
Can the endo write a letter or something to appeal the decision? Most insurance companies have several "rules" for pumps that don't get look at an A1c. In my case, hypo unawareness was a big one. ER visits was another, plus the big swings in daily numbers.
That is what happened with my insurance company. While I was pregnant with my son my A1C was 5.1. After I gave birth they tried to put me on an insulin pump, and the insurance company denied it a couple of times. Then a year or so after my A1C went up to 7.6 and they approved the pump for me. I didn't purposely not take care of my self, but that is pretty much the only reason I was approved for a pump.