Insurance and the Pump

My son, age 10, was denied for a pump by our insurance company because they said he has not been diabetic long enough; even though he has a recommendation from the doctor, the hospital, and his endocronologist team.  He was diagnosed in July.  We have appealed the decision but have no answer yet.  Has anyone else encountered this problem? 

Jackie-  You must be doing a fantastic job of managing your son's diabetes for your endo to okay a pump so quickly!  I am a pediatric RN and I had to really push to have my daughter's endo prescribe a pump at 8 month post diagnosis.  Her endo group wants everyone to take carb counting classes, prove that you can do that well while still doing injections.  We didn't have any problems with our insurance company.  My advise to you is to fight it and to keep pushing as far as you can.  A pump generally means tighter control of blood sugars which translates into fewer long term complications.  A pump would be much less expensive for your insurance company compared to the treatment of complications.  I don't see any health benefit to your son by waiting for a pump so long as you and he are comfortable with his care and understand all the ins and outs of diabetes.  Some people are more comfortable than others.  I have been making changes to my daughter's insulin doses since she was out of the hospital 2 weeks.  Even on her pump I make changes completely on my own all the time.  Some parents would rather not take this on and want the endo to do this.  Everyone is different and your insurance company needs to know you are comfortable with taking care of your son's diabetes and that the challenges of using a pump will not be a problem. Best of luck to you and your son.  I have found that being very persistant usually pays off.




Jackie in the past, the conversations I have heard talk about their children and the pump, is that most insurance companies wait until the honey moon period is over before moving forward with pump treatment. I think it is to make sure everything is balanced before moving into a new mode of treatment, also I am sure they have some study or feasibility scale of them paying out for a pump pre honeymoon and since things changed so much, the user stopped with the pump completely thus wasting all the money that was put out for the pump.

I have never been in this situation because I flat out demanded a pump for my daughter after her diagnosis. She was diagnosed in May of 08 and pumping in July of 08. I pulled out the b&*%ch card and insurance backed down immediately. Don't take no for an answer. Fight for it. It is so worth it!