Pump/Insurance help

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Pump/Insurance help


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Old 06-24-2015, 15:10   #1
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Default Pump/Insurance help

it's been a while since I have see you all, I will have to come back :-)

I have type 1 and am on Injections currently (50 units of Lantis at night, and whatever needed at mealtime of Nuvalog). My Endo and I discussed switched to a pump last year about this time but because I was going on my honeymoon and didn't want to be new to a pump in a foreign country we decided to wait until after Christmas. Also there is a new Animas(sp) Pump that goes with a Meter (I forgot the brand). Since they work together we decided to get me set up on that.

Now comes the fun. The insurance company approved the Meter but not the pump. Now the meter itself is WORTHLESS without the pump unless a receiver is purchased. Obviously I didn't buy it because its a useless expense because the meter works with the pump so I don't need it. Well the insurance is now refusing the pump because my eating and exercise habits aren't up to their standards. (which I admit they are not the healthiest)

My Endo and my original endo from a few years ago have both said they have NEVER had someone get denied a pump who was Type 1. ESPECIALLY after being approved for the meter that is useless without the pump unless you purchase a 3rd device. They are willing to let me resubmit the request in 60 days, but I need to go see a nutritionist, take a class in using insulin (which I am not against per say if its how to use it with a pump) and go to my Endo every 3 weeks during the 60 days.

Is this all BS and should I consult with a lawyer? And of so, what type of lawyer? I feel the only reason I was denied is because by purchasing the meter I hit my deductible so I won't have to pay a large portion of the meter costs. I mentioned it to my endo and she said they have quite a few years between her and my old one and they have NEVER heard of a problem like this before. They both work together, its just one is about 3 miles from my work so I switched due to being able to go during lunch instead of taking a half-day from work.

Sorry for the long post.

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Old 06-24-2015, 15:47   #2
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You should find out what the criteria they use for a pump. If you have not been on MDI for six months, then that may be the reason for denial.

Anyway, go to the website whatever and find out what the criteria they used, and go from there.

The doctor can submit papers for medical necessary.

Learning insulin regimen whether MDI and/or pump is about the same. What you learn with MDI will carry over to the pump. I was one of those that tried to mimic my own pancreas activity using MDI, so what I learned on my own was exactly what I needed for managing the pump.

Hope it all works out for you.

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