I am wondering how many of you were declined the first time your doctor recommended for a pump? What kind of hoops you had to jump through in order to get your pump? How long did it take you from start to finish to get approved for the pump?
All of my doctors have told me that I would be a great canidate for a pump. My problem is that my insurance company did not like the way my endo. worded the letter sent to them so they declined me. I want to reapply for the pump but I do not want to waste my time reapplying. Any hints on what I can do to get the insurance company to say yes?
The pump representative should be able to give you guidance based on your specific insurance plan. You may need new blood work or a stronger letter stating why a pump is medically necessary. Things like visits to the emergency room, ems being called to your home, not able to feel symptoms of low blood sugars, high blood sugar variability, onset of complications (cardio, eye, kidney, and nerve damage). Detail this specifically - basically show them how going on a pump will save them money in the long run. Good luck with it…
If you don’t get approved for a pump when you try again, you could ask insurance company how they would like that recommendation to be worded.
The insurance company is bad about not being able to find the paperwork that gets sent to them. I have had to tell them when faxes were sent in order for them. It takes them at least 10 working days to put the new paperwork with the old paperwork. It then takes them another 10 working days to make a decision. The insurance company has stated that they would like a phone call from my doctor and not just another letter. Right now I can think of many reasons why they do not want a paper trail and not very many of them being good reasons. I am going to continue to fight for this pump until I win this fight no matter what.
I admire your fortitude!! Continue your fight I hope you are victorius. You have to be persistent when you want something especially a pump. Let me know if you are victorius.
I agree with logandog, having your pump rep on your side will definitely help. Also, talking to your insurance company personally couldn’t hurt either. Ask them this question…pay for an insulin pump that has been proven prevent and sometimes reverse complications, or process numerous claims in the future for dialysis, transplant lists, retina surgeries, etc. That’s what I did ten years ago, and suddenly two days later, I was approved for my first pump. Good luck.