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RE: [IP] Too good hbA1C?



My Insurance had these requirements:

The pump must be ordered with concurrence of an endocrinologist.
A diagnosis of diabetes mellitus ( ICD-9 codes 250.01, 250.03) requiring
insulin for proper treatment.
Documentation of a history of completing a comprehensive diabetic education
program and compliance with multiple insulin injections where 3 to 4
injections per day fail to provide normoglycemic levels.
Member has demonstrated ability to self-monitor blood glucose levels >/
4x/day

I am a type 2 diabetic. The ICD-9 codes 250.01 Diabetes, I, uncomplicated
250.03 Diabetes, I, uncontrolled. The insurance company was saying only Type
1 Diabetics would get a pump.
I was denied by my insurance the first time the doctor submitted. The second
time I had him put copies of my log in the request. The log showed that I
tested 8 - 10 times a day. That I have a Dawn Phenomium. And that my A1c of
5.8% included many lows that averaged out the highs. And that my meal plan
was being adhered to. The HMO denied me again. The third time I had the Endo
do a c-peptide test, which showed very little insulin production. That was
the winner, I got my pump. I don't know if I am Type 1 or Type 2. I know I
was type 2 for 22 years. 

John S Wilkinson, 
Rome, New York
 
 


-----Original Message-----
From: email @ redacted
[mailto:email @ redacted] On Behalf Of email @ redacted
Sent: Sunday, July 30, 2006 5:06 PM
To: email @ redacted
Subject: [IP] Too good hbA1C?


I joined this list a few months ago to learn about insulin pumping since I
am 
hoping to get an insulin pump to use since I am tired of being a pin
cushion. 
 My Endo has submitted my paper work , and I was denied based on my last 
hbA1C of 6.4, my last before that was 8.2 in November of 2005, but I have
been 
working hard to get it under control with MDI.  I like feeling much
better,but 
 between the symlin and the insulin I am taking I am taking 8+ injections
daily. Does any one have any suggestions on how to deal with insurance
without 
backsliding in my control?
Thanks
Joyce
.
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