I have Aetna. Here is Aetna's current criteria (you qualify either under (A) or (B)):
A.Members must meet all of the following criteria:
1.The member has been on a program of multiple daily injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin dose for at least 6 months prior to initiation of the insulin pump*; and
2.The member has completed a comprehensive diabetes education program; and
3.The member has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump**; and
4.The member meets at least one of the following criteria while on multiple daily injections (more than 3 injections per day) of insulin:
a.Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dL; or
b.Elevated glycosylated hemoglobin level (HbA1c greater than 7.0%, where upper range of normal is less than 6.0%; for other HbA1c assays, 1% over upper range of normal); or
c.History of recurring hypoglycemia (less than 60 mg/dL); or
d.History of severe glycemic excursions; or
e.Wide fluctuations in blood glucose before mealtime (e.g., pre-prandial blood glucose levels commonly exceed 140 mg/dL); or
B. The member has been on a pump prior to enrollment in Aetna, and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Aetna enrollment.
Aetna has dropped the c-peptide qualification, but I would have to show poor blood sugar control in order to qualify. It is important to note that Aetna has modified their policy (as of 2/3/12) to "remove the requirement of beta cell autoantibody positivity or low fasting serum C-peptide level as a prerequisite for use of an insulin infusion pump." Medicare requires a c-peptide below 110% of the lower end of the reference interval, but not Aetna. All I have to do is demonstrate self-destructive behavior.