This might be a dumb question, but I know how supportive the TuDiabetes community is, so I’m throwing it out there:
I want a pump, but how do I get one?
Right now I inject insulin manually (is that what you’d call it?!). I inject my basal insulin (Levetra) in the a.m. and p.m. and I bolus (humulog) every time I eat.
I’ve heard a lot of you here on TuDiabetes and on Twitter talking about getting approved for a pump through your insurance company. And I’m so curious, how do you get started on that process?
I haven’t seen an Endo yet. Keep in mind that my health insurance just started covering diabetes May 1st, so in the past two years I’ve tried to survive seeing nurse practitioners (when I was paying 100% in cash) and family practice Drs (when my insurance covered everything but diabetes).
Someone give me some advice.
What makes someone a good candidate for a pump? What are some reasons that a health insurance company would deny a pump “prescription”??
Mike,
You gotta go to an endo ASAP. They write and RX to the pump company once you decide which one you want. I suggest asking the endo what kind of relationship they have with the pump reps to see if you can get a loaner to try multiple pumps. The doc will also have to fill out paperwork for the insurance company proving medical necessity for the pump. This will be no problem for you since you were just in the hospital due to DKA.
What makes you a good candidate? Being T1 or T1.5 is a big reason. Alot of insurance companies fight giving pumps to T2s for some reason. A desire to bring down your a1c is another reason you would be a good candidate. Doing MDI (more than 2 shots a day) helps you case. Having problems with crazy blood sugar trends helps. I actually got turned down the first time I asked for a pump because I only did 2 shots a day and I hadn’t been hospitalized due to BG issues!
Why would they deny you? They don’t want to pay the upfront cost. They may have a policy that they always deny people the first go around to see how serious you really are about a pump. They may want to be sure you are seeing an endo for a certain amount of time, like 12 months, before they OK it. They want to make sure if they buy you this expensive piece of equipment that you will actually use it and see the endo like you are supposed to. They may want a 3 to 6 month records of your BGs to see if you really are out of control so if you don’t have this, they say no. It all just depends on how your insurance policy is written.
I am sending you positive thoughts and wishes that your insurance company is one of the cool ones that says OK just because the endo said it was medically necessary 
