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Re: [IP] Insurance Coverage

In a message dated 98-12-13 16:49:29 EST, you write:

<<  What are the criteria used by insurance companies to accept or reject a
 > claim for the pump and supplies?  I know this varies from company to
 > company.  How about the Blues?
 > Minimed needs a letter and a prescription.  What is in the letter?
 > >>
I use standard form letters provided by MiniMed or Disetronic.  With a bit of
editing, I plug in the individuals need for the pump. Insurance wants to see
that you have evidence of early complications,  or existing
complications,erratic lifestlye or work schedules, failure of BG control with
multiple dose injections, the ability and capability to manage the pump.
Evidence of gastroparesis, retinopathy, nephropathy, vascular complications,
desire for BG control in pregnancy, kidney transplant will usually have pump
approved. Lab values, glucose records, A1C value, are usuallyrequired as
supporting evidence.  The individual insurance company may decide exactly what
they want look at. They requently want to know that multiple dose injections
are not working for the potential pumper. They also want to see that an
individual and MD have worked toward normal BG control with intensive
management...one or 2 injections per day is a cause to reject pump coverage
because it may indicate that more intensive regimens have not been tried.
Keep in mind,I do not work for the insurance companies.)
        Once I have a letter prepared, I give it to the endo to review and
edit, then send it off with the prescription (MiniMed letter). The basic
letter from Disetronic only requires the MD to write in or check off specific
items that apply to the potential pumper.
         I hope this is helpful.

Barbara B.
Insulin-Pumpers website http://www.insulin-pumpers.org/