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RE: [IP] Re:New to list

Actually, Most Insurance companies look at the following:

1. Hb A1Cs  (specifically those over 10)
2. Attempts at bringing BGs into control using MDI
3. Complication status of the individual.
   (those individuals with beginning onset of some
    complications are better candidates according to
    some insurance companies.)
4. Frequency of low blood sugars

Remember that good documentation ( multiple logged BGs) of BGs is good to
have, because you may have an Hb A1c
that is below 10 and still have wild swings in BGs.

A good letter of medical necessity will also assist with getting the prior
approval that is necessary.

Also, look at what your insurance covers for DMEs, most companies have
followed suit and do not charge a co-pay for diabetic DME supplies, yes the
pump is a DME.


> -----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On Behalf
> Of email @ redacted
> Sent: Sunday, February 07, 1999 14:17
> To: email @ redacted
> Subject: [IP] Re:New to list
> Hello Everyone,
> I have been reading the digest version for about two months.  I
> have a 15yo
> son who was diagnosed with IDDM just before his 8th birthday.  He
> is on three
> shots a day (Humalog and Lente).  We have been discussing a pump
> for almost a
> year.  His endo said Josh has to really want it or it won't work out.  His
> Nurse Practitioner told me that insurance companies have been refusing
> coverage unless a person is on MDI and has at least 4 blood sugars/day
> documented.  I have written to our insurance company to check out coverage
> (usually 80%). Was that a mistake?   Should I just drop it or pursue it
> further?  Josh has some issues with the pump that I believe would
> be resolved
> if he could use a loaner.  Thanks for all the info- you all are
> great!!  BTW-
> I am an RN  and we live in Louisville, KY.     Annette
> ----------------------------------------------------------
> Insulin-Pumpers website http://www.insulin-pumpers.org/

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