Minor Panic Attack over Qualifying for Pump

I'm filling out the paperwork for our son's pump.  I have to submit a 3-day food/carb calc log to the Ped Endo, and an 8-week BS log for the insurance company, along with some other forms, to get the ball rolling on a pump for William (8).  We've been at this for 11 months now, and he REALLY wants a pump.  He even came to the Pump Prep class with me yesterday.  But, as I write out the log sheets for the insurance company (our original log sheets are bordering on illegible and have to be transcribed), I'm having a minor panic attack.  I feel like I've been a complete failure at adequately managing William's BS because he's not "on target" 99% of the time, and that he'll be denied a pump because of my incompetence. 

Has anyone been denied a pump by their insurance company?  Was it because of poor BS management, or "other" reasons?  Am I freaking out for no reason?

Taking a deep breath...

Mo

 

Take a deep breath!!  It'll be fine.  My Daughter JUST went on the pump.. it's been a little over 2 weeks now that she has been on it. I understand your anxiety but things will be ok.  No one is on "target" 99% of the time and if someone is and they are reading this please tell us how you do it!! :) He will get the pump and love it.  My Daughter is 11 and she loves it!! She is on the OmniPod. She says she never wants to go back to shots.  It is a lot of work but sooo well worth it!  Good Luck!!! :)

~Jill

 

 

I don't really have any advice to offer, as I haven't had to deal with this.  I'm still using needles, which is a shame on me, since Ontario approves the pump for all Type 1's.  I just wanted to comment that I think it's so weird that insurance companies can DENY a device used to regulate blood sugars, based on the fact that they're not regulated well using syringe therapy.  Isn't that the point of the pump, to gain better control when syringe therapy isn't effective?  If anyone has been denied, is it because syringe therapy wasn't effective, or is it because they themselves were being ineffective (ie not testing, not recording, not treating etc) ?  This confuses me, and makes me dislike insurance companies even more.

As far as the illegible log sheets, maybe you could send the originals along with the transcribed ones, just so it doesn't appear faked at the last minute???? I don't know, what I do know is that I'm rooting for you and William.  Try to stay vigilent, and do your best not to be so hard on yourself.

the first attempt mine got denied. all i had to fill out though was a form animas gave me for my endo to fill out and fax to my insurance company. it wasn't enough info(only asked a few things like how long i have been diagnosed, my last two a1cs, etc).

when it got denied, my endo just had to write a short letter, explaining why i wanted to try it and couldn't control my D with needles, to the insurance company(was advised by animas to ask him to do this) and they approved it.

it's a LOT of money for them to dish out, so for things like pumps I've heard they are harder. but it sounds like you're giving them way more information then i did the first time.

 

good luck! and don't worry, if you get denied the first time it doesn't mean you can't keep trying!

Maybe I just got lucky both times, but I've been through two different brand pumps (and two different insurance companies) and never got denied.  Both times my doctor wrote a letter (for my most recent pump, two of my doctors signed it - they said they thought "it would help"...  ha!), gave them blood work results showing my last several A1C's, and filled out a questionairre about me being motivated, and how often I experience hypo- and hyperglycemia, etc.  Sounds like you're doing everything you should to get an approval - so all I can do now is wish you good luck!

If I remember correctly one of the requirements to start pump therapy was an A1C below 9. I think that's crazy too because like somebody else mentioned, the whole point in getting the pump is for better control. Mo, I know exactly how you feel. When I look over my son's numbers it seems like he's high or low more often than he's in range, but his last A1C was 7.9. For his age his endo likes to keep it between 7 & 8, but I hope for closer to 7, or lower, when he gets his pump.

Thank you, everyone, for your support.  I went walking with a girlfriend last night and ranted for awhile.  Feel much better this morning, and ready to finish up the paperwork.  William's last A1c was 7.1 (right after the holidays).  I wouldn't be so anxious about this if it were just for me, but it's for my son and he really wants a pump.  We're coming up on his 1-year anniversary next month, and I think I've been fighting off the stress for too long.

Taking a deep breath.  Forging ahead.  Thank you, friends!

Blessings,

Mo

Best of luck Mo, I hope it all works out without any denials =)

Best of luck to you. I was not denied, but I did have to work with my endo to get them to approve me for a pump. At the time I was having complications due to diabetes on my eyes, and had already meet my out of pocket expenses for the year, so my motivation was purely financial to get approved before the end of the year. I spoke it over with my ophthalmologist, and he wrote a letter for me to the endo to say if I was on a pump I probably wouldn't have had complications. After that I switched endos as they didn't understand why. Needless to say, I did get approved before the end of the year and got my pump for free. I wouldn't recommend this route for anyone, it just happened that way.

I know Medi-Cal is different from "real" insurance, but when I first got a pump from them, they WANTED my BG's all messed up.  They figured if my numbers were ok, I didn't need a pump.  After they approved me, MM told me they wanted BG logs every 90 days.  They wanted THOSE numbers to be better.  I was told by MM that if my BG's didn't improve, and if I couldn't show I tested at least four times a day, Medi-Cal would take my pump away from me.  Strange, since I switched to an Animas pump three years ago Medi-Cal has not bothered me once about submitting BG logs!  I wonder if that will change now that I have "real" insurance.

UPDATE:  William was approved by insurance and all paperwork processed in a matter of days.  This first Pod shipment went out yesterday, and should be here by Tuesday.  His "saline starte" will be May 4th, and insulin start on May 13th...exactly one year from his dx.  Weird, huh?

Feel like I can breath again now.  Thanks, everyone, for your support!

Blessings,

Mo

I have been on the pump for about a month now...over 15 years of shots and it is great. I have to say the the hospital where my doctors are handled ALL the paper work. I WAS denied by my insurance company,  but the doctors really pushed for this for me. The pump company was just as much help, they also did alot of the prep work for the paper work. Most major insurance company will see poor BS as a good reason to approve the pump, less problems in the future. Talk with your sons pump rep. they should be able to help.

That's great news Monique, congrats!