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[IP] To: Barca-Tinus Family, pump approval "tricks"



Hello (sorry, I'm not sure who I am responding to here):

While many insurers prefer to see that you have tried multiple injection
therapy, it is not *required* for them to grant approval for a pump. This
policy may of course, differ among the various insurance carriers. One of
the reasons for this request by the insurers is to see if you have tried
all available therapies for managing your diabetes.

One of the "secrets" for obtaining insurance carrier approval is good
documentation. Document your BGs, your A1C levels, your highs, your lows,
your hypos, problems you have, etc. This information will also help your
doctor make his / her case in your behalf.

When I got my first pump, things were proceeding well until we encountered
the "auditor from hell". This person could not be moved with a Mac truck.
She questioned everything (in all fairness, I guess she was supposed to be
thorough, but I wasn't crazy about her attitude). We started to make some
progress, and when I called to check on the status, I was told that the
pump request was on indefinite hold, since the insurer had no evidence that
my BGs were "out of the normal range" (despite my doctor's letter, etc).
Seems like they ignored most of what we had sent them.

I just sighed and told the auditor to "Clear me a phone line, Champ. I'm
going to fax you 15 years' worth of written records along with my computer
printouts. With any luck, the phone line will clear in about 2 days. Make
sure you leave yourself a clear exit path to the door and stock some food
and drink. It's going to take you a while to sort through the evidence".

My health care team got a call about an hour later with my pump approval ;-)

Thorough record keeping also came in handy a year later when I needed to
replace my pump, switching to another. Although the insurer wondered why,
once they had my documentation, they did not argue.

Bob

mailto:email @ redacted

>hey Brian I was diagnosed about six months ago and was also "moved" to 2
>shots of Humalog/NPH. Th doc now wants me to move to 3 shots: mixing in
>morning, H at dinner and NPH at Bed. Would also like to go to pump and
>understand insurance cos. want to see that to cover ya. Anybody else have
>problems in this area? Convincing insurance cos. Nobody right??Welcome , I
>don't talk alot, but read alot and am hoping to respond more. This is a
>great group, especially the Saras, Buddys, Michaels, Teds and other
>contributers.This IS the place check the On-line shtuff. Later.
>
<snip>
Bob Burnett

mailto:email @ redacted
Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/