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Re: [IP] Dr. Bill

> In a message dated 9/17/98 5:11:34 PM Eastern Daylight Time,
> email @ redacted writes:
> << Maybe Dr. Bill is Ted's long, lost relative and he's been lurking.. >>
> He could be related to Ted...but he is an MD.  Check out the current issue of
> Diabetes Interview.  Let's be kind, folks. <bg> The info he is requesting help
> with is not readily available from insurance companies, to the best of my
> knowledge. Also, I do know that with some insurance companies, the final
> approver of someone's pump could be a retired MD with no prior experience with
> pump therapy and might not even be an endo.

Blue Shield of Calif has the following guidelines
Quote from a letter received from them dated Apr 24, 1996

"In order to complete our review, our medical policy dictates that we 
request the following information:

1. Documentation of a history of poor glycemic control
2. Documentation of poor glycemic control on multiple daily 
injections of insulin, including persistently elevated glycosylated 
hemoglobin level (including laboratory reports).
3. Documentation of widely fluctuating bolld glucose levels before 
4. History of severe hypoglycemia or hyperglycemia.
5. Frequent hospitalizations of emergency room visits.
6. Dawn phenomenon where fasting blood glucose level often exceeds 
200 mg/dl.
7. Treatment of secondary diabetic cmplications requiring tighter 
blood glucose control.

The patient must have demonstrated ability and commitment to comply 
with a regimen of pump care, frequent self-monitoring of blood 
glucose and careful attention to diet and exercise.

Please blah, blah, blah "

I requested payment for the pump AFTER we had it, although it was 
prescribed by a Blue Shield doc, delivered by a BlueShield provider 
and NOT paid for by me. I waited until they paid, took a year and a 
half. To finally get reimbursement I had to request administrative 
review, since BS would not pay initially. I sent them this letter in 
response to their request for info (above). Lily started on the pump 
5 months after diagnosis.

 ************** letter *********************** 
In response to our telephone conversation of last week, I am 
enclosing the available medical records from the Packard Children's 
Hospital. The blood sugar levels reported in the Packard documents 
would indicate HbA1c's in the range of 9-10 using standard conversion 
formulas, clearly not real good.  Since starting CSII, Lily has 
maintained HbA1c's in the low 7's and below.  Her most recent HbA1c 
(last month) was 6.75, clearly a remarkable achievement for a 12 year 
old who maintains her own control regimen.

Since 1923 it has been recommended by diabetologists that blood sugar
levels be maintained as close to normal as possible.  In 1993 it was
unequivocally demonstrated by the conclusion of the 10 year Diabetes
Control and Complications Trial (DCCT) that intensive blood sugar
management dramatically reduces the risks and complications of
diabetes.  The most effective method demonstrated to achieve tight
control was the use of an insulin pump.  The results of the trial
demonstrated for the intensive therapy group a 76% reduction in the
risk of development of retinopathy , a 54% reduction in incidence of
nephropathy (kidney disease), a 60% reduction in incidence of
neuropathy, a 34% reduction in the development of high cholesterol,
and  a 41% reduction in the risk for heart attack and stroke.  These
results translate directly to Lily's reduced risk resulting from
lowering here HbA1c's from the 9-10 region to the 6's, with a
corresponding reduction in the cost of long term medical treatment.

I hope you find the information I have forwarded to you satisfactory. 
Please contact me if I can be of further assistance in this matter.
************** end letter ************************

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