We are in the process of getting the pump for my 6 1/2 year old daughter.
We ordered one & when they called to check with our insurance, they denied it saying it was not a medical necessity for her to have the pump. Has anyone had any issues with their insurance getting a pump to be approved? Does anyone have any suggestions for getting the insurance to cover it?
My insurance company won't cover a pump for me either because I have good control over my diabetes using shots. How is that fair? I should be rewarded for taking care of myself...
Best of luck, hopefully you can find a way!
You might check with your endocrinologist, if you haven't already, to see if he / she could write a letter substantiating your daughter's medical neccesity based on the need to stabilize her blood glucose, especially given her young age.
I hope you get some help and can resolve this for all of you!
Take care,
Amy H. (new member)
Did you haveyour doctor write a letter of medical neccisity to your insurance company that might work for you. I had to have that done a couple of times. If you didnt have to od that it might work for you.
I sadly don't have an endo. Only people with serious complications and issues get referred to endo's here.
i wanted the omnipod and the company completely denied it so i'm trying to get a different one the only problem is that i ride horses and i'm afraid tubing will get in the way
Get anyone in the medical proffession to write whatever they can!!! Insurance companies don't worry what is best for us, they only want what they percieve as cheapest. One thing I have learned about insurance, the squeaky wheel gets oiled. Don't give up on it. I find it crazy that you can't see an endo!!! All diabetics should be able to see an endo. I see only an endo, I have no PCP. I have been T1 for 40 years and have luckily remained healthy so far. I believe alot of it has to do with my being able to see the Drs., CDE's, nutritionists, etc. etc. that I need to see.
I have heard of all kinds of excuses for insurance not to authorize pumps. You have good control, don't need one. Your control is not good enough to warrant you having one, on and on and on.
I know that it IS possible to get one.... I never even had my insurance question my use of the pump, I think my endo's office just knows how to handle the insurance companies so it's not such a hassle.
Hang in there and be a squeaky wheel!! Definetly have your current Dr. write a letter. If that doesn't work, seek out an endo, however you have to do it. I wonder if your insurance would think it's a good idea for a diabetic not to see an endo? It's almost like telling someone with cancer that you don't need to see an oncologist. Insurance just irritates me so much!! I've been dealing with it a LONG time.
Good luck. Let us know what happens.
Depending on your job situation, I might suggest looking at other insurance plans offered by your/your spouse's employers. I have blue cross/blue shield and, while they aren't as good as the insurance I had when I was on my parents' insurance in college, they do cover 80% of pump supplies.
Strange that they would reject the request for a pump though. It really does make living with Diabetes easier and more manageable.
Who is your healthcare provider? (if I may inquire)...
The tubing from the pump does not come out easily. Most of the time, mine is neatly tucked inside of my pants. If it is a problem, you can always put the pump in your pocket and snip a little hole on the inside of the pocket. That way, there is no tubing exposed. I tried the Omnipod and did not like it. I kept losing the PDM (the little computer *brains*) of the pod. Not only that, it stuck out unerneath my clothes and made me feel like I had a tumor. That's my own experience, I know others love it. I prefer to have everything I need in one little area that is always with me.
I have healthnet
I'm looking at the Health Net benefits page, and it looks like pumps & pump supplies should be covered. The link to the PDF document is below, but here is an excerpt: "Durable Medical Equipment including coverage for glucometers, insulin pumps and insulin pump supplies. Certain devices may require prior authorization..." It says of the aforementioned that they are covered at 80%.
The certain devices requiring prior authorization piece is I guess where they got hung up on. Did you inquire as to if it was specific to the type/brand of pump being requested? Or are they just being cheap? One would think that an insurance company would let a doctor (who I assume recommended the pump) decide what is best instead of letting the almighty dollar get in the way of someone being able to more easily manage their diabetes.
https://www.healthnet.com/static/custom/unprotected/pdfs/ebmda.pdf