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[IP]Insurance Companies and Their Game
[sorry so long]
hey guys, I am still looking into getting a pump,
but decided to research into their policy before
getting more excited about it. [Yeah, right.]
Well they have their policy posted on the internet
and its states the following:
* Patient has insulin dependent diabetes (IDDM, Type I)
* The pump is prescribed by an diabetologist familiar with
insulin pump management.
* Patient is capable of and committed to intensive insulin
therapy, as demonstrated by achieving a HgbA1C of less
than 9 while on multiple daily insulin injections.
* Patients must be willing to monitor blood sugar at least
four times a day, and follow prescribed eating and activity
patterns. If a patient is unable to achieve reasonable control
with injections, it is not likely that an insulin pump will improve
blood sugar control.
* A trial period with the pump, lasting one or more weeks
(arranged by the physician or other mechanisms), demonstrates
that the patient is capable of managing the pump.
Ok, the first is pretty easy since I have been a type I for
19 years now. The third isn't bad since I haven't gone
over 9 in over 6 years, and am on 3 shots a day.
The fourth, is easy since I am already doing 5 tests a
day. I eat when hungry and play tennis actively.
The fifth is after the fact, can't do anything about it now.
The second however is the loophole.
definition of diabetologist :
diabetologist: an internal medicine doctor who has specialized in
endocrinology, and further "subspecialized" to work with diabetic
I am new to the area and figured why not find out first who in their
network they consider to be a diabetologist before I get a new endo.
When I called the insurance company the first time they reread me the
policy and when I asked they told me to look in the providers handbook.
[A phone book of doctors]. Ok, so I did. No section on
diabetologists. However two sections of importance...Endocrinology
Specialists and Endocrinology-Diabetes and Metabolism Specialists. This
should be a no brainer I know, but I got a really good recommendation by
two people I have met here who love their endocrinologist. One is on the
pump. The other is trying to be convinced. But he falls under the
endocrinologist section. SO I called the insurance company a second
time to see if these were the categories they meant and if doctors in the
Endocrinology section would count too because of the "definition." The
woman over the phone told me and I quote: "Don't listen to the policy,
it is a bunch of hot air. All you need is a letter of necessity from
your PCP and you send this to the pump providers and they work it out
with us." Seems a little to easy to me. Makes me queasy. I know they
cover pumps, so why wouldn't I go to a specialist and follow the policy
so they have nothing to turn on me with. I need an endo anyway.
Let me know what you think,
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org