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[IP] insurance denial letter

We were denied by Pacific Care:  their statement went:  Insulin pump devices 
are not recommended for children under 15 years of age.   Because of the 
controversial nature of insulin pump use in pediatric patients.  Discussions 
were held with a pediatric diabetic consultant and with the medical director 
of your health plan.  There was consensus that an insulin pump is not 
appropriate at this age, especially if there is relatively good control of 
diabetes utilizing standard methods.

They argued that (after fine tooth combing through her medical chart) the 
doctor said Summer's control was excellent.

My appeal was 20 pages thick:  lots of downloads on kids' profiles, data and 
graff supporting pumping, etc.  My doctor wrote this scathing, and fantastic 

I was stunned to find that your company is using the phrasing "excellent 
control" of diabetes to deny coverage of ________ transition to the even 
better control available by use of the pump.  This decision is a perverted 
reading of a medical dictation and an outrageous distortion of medical 
decision-making.  Summer's family has been assiduous and diligent in their 
use of Humalog and NPH.  They have taken Summer's control to the maximal 
exten tpossible using subcutaneous injections.  Her hemoglobin A1Cs in the 7s 
rreprersent "excellent control" in the context of the control achievable with 
this limited technology.  I used the phrasing simply to praise them in my 
letter to their pediatrician.

Everyone involved in diabetes management is aware that even this "excellent 
control" achieved by subcutaneous injections can be improved upon by moving 
to the pump.  As demonstrated by the DCCT, even a marginal incremental 
improvement in HA1C translates to long-term delay in the terrible 
complications of diabetes.  This is the whole point of diabetes control.  To 
deny use of superior technology condemns Summer to earlier onset of 
complications.  I find it hard to believe that is the intent of your decision.

In addition to superior control, the pump is a safer technology for 
delivering insulin.  In my dictation in question, you  must note my reference 
to hypoglycemia occuring "quite frequently" in conjunction with Summer's 
current management.  This danger of loss of consciousness, seizure, and 
permanent neurologic sequelae can be ameliorated by transition to the pump.

Finally, you must understand that use of the pump is largely limited to 
families who have already demonstrated the dedication required to achieve 
"excellent control."  You should not pumish the _____family because of my 
apparently inuudicious use of this term, particularly since most families are 
in this category as a prerequisite to management of pump techynology.  Please 
reconsider your decision, which I find depressing and abusive of medical 
management prerogatives.
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