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Re: [IP] Another Denial.....Grrrr (kinda long)

Steve wrote about his insurance denial:

>>But.......according to them:
"The medical services are not certified because the patient has acheived
excellent control of his diabetes with his current regimen. He is not having
frequent or severe hypoglycemic episodes. For this reason, use of an isulin
pump is not medically necessary"

Where did they come up with that??<<

Steve, before I started on the pump, my A1c's were always in the 5 range.
Mostly because, like you, I had a lot of lows and wide swings in blood
sugars.  I'm not sure who your insurance is, but mine had a number of points
that qualified you for pump use and only one of those was the A1c
measurement.  I met the criteria on all the other points:  wide swings in
blood sugars; history of severe glycemic excursions; day to day variations
in work schedule, mealtimes, and/or activity level, which confound the
regimentation required to self-manage glycemia with multiple daily
injections.  This was all documented by my endo on the letter of medical
necessity.  My insurance approved without batting an eye even though my endo
put that my last A1c was 5.2 .  It also stated that I was very compliant and
followed all his recommendations for controlling my glucose levels.  Not
sure if you need something more here, and I'm not sure who your insurance
is, but I agree that more than just one factor needs to be considered before
approving a pump.

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