Insurance Follies

Sp get this - my insurance (Aetna) approved me for a CGM - it arrives tomorrow - but Animas is saying they don’t think I will qualify for a pump. They had me get a fasting C-peptide test, which came in higher than anyone expected - just within the range of normal, which is great news - I’m still in my honeymoon period… but Animas thinks Aetna won’t approve the pump now. Aetna officially requires a C-peptide below 110% of the low end of normal, or presence of beta antibodies, to approve a pump. I had a positive GADA test last year, which is when they decided I had Type 1 (or LADA) and not type 2 diabetes (that and the fact that oral meds and diet were doing nothing to improve my condition) - but Animas says that Aetna requires an IAA test, not a GADA test - and from what I’ve researched, less than 40% of LADA diabetics actually test positive for IAA.

BUT Medtronic had already told me that Aetna had approved a pump for me and were ready to go ahead with the order before I decided to go with the Animas pump. So it would seem I can get approved for it, but somehow Animas is not getting it through. My CDE thinks I am a prime candidate for pump therapy, and that if I’m up for it, it could really help me manage my health (especially allowing me to do more strenuous exercise). GAAAAH!! I don’t get it.

So this is what it’s like, eh? I’m only one year into this diabetes thing, and a lot of the time it’s no big deal, but then sometimes I get completely obsessed and frustrated.

I’m really surprised to hear that… anyone on injected insulin can test positive for IAA - that’s not a definitive test to determine what type you are if you’re using insulin. It can only be indicitive of T1 if it’s tested before insulin therapy is begun (eg right at diagnosis).

From labtestsonline - “The IAA test does not differentiate whether the body’s immune system is making autoantibodies against insulin or if the immune system is making antibodies against insulin that has been injected (either human or animal) in the treatment of any type of diabetes.”

I would think that the GADA is more than sufficient - did you have ICA levels done too? If you had both, I really can’t see them denying a pump based on being “unsure” of the type of diabetes you have.

Well that’s really ridiculous then… Maybe I’ll go ahead and get the IAA done - if it’s positive, then I’ll get approved anyways, even though it’s meaningless. Thanks for the feedback, Sarah!