So i been being in touch with pumps it which helps with pumps and cgm or rather a middle company that does it and i was told today my insurance denied the pump for me stating medical necessity was not established and the rep said i could file a appeal… How often has this happened to anyone and how likely is it that the appeal will work because my sugars are still running a bit high with my A1c being 7 or so which even my dr said is a bit too high, i have my cgm but if i have the pump it will decrease the highs especially when im sleeping… any suggestions or idea would be helpful.
Keep appealing till they say yes. Have your doctor write a new letter going into more detail of why you need the pump. Do not give up. It took me almost two years before they approved my first pump.
well this is my 2nd one the 1st one only took like maybe 2 weeks
I agree. Appeal the decision as many times as it takes. Medical necessity is determined by the information your doctor provides the insurance company. He must give them good medical reasons for you to get a pump. Evidently he did not do that the last time. Maybe he should contact your insurance company to find out their criteria for approving a pump. You may already meet their requirements but the doctor didn’t state the proper information in the medical necessity paperwork he filled out.
I agree with Phil. Find out what the requirements are with your insurance company for the pump. It might be something as simple as your doctor did not check off a box. I did not even know it unitl I emailed the salesman that mine had been approved, but there was apparently a mixup in my paperwork and my doctor had to re-do something to get it straightened out. My pump was approved.
Have the doctor also write the letter do no just have them fill out the form. The more the detail the better.
Ok 2 stupid questions. Is your old pump out of warranty and do you have the same insurance as you did when you got the first pump?
no my pump i got on march 2008 and my insurance company said the current pump situation doesnt matter as long as its medically necessary i discussed it with them twice already and they said its not a issue at all, they will cover it and im guessing per the 1st post that some missing information wasnt recieved by the insurance hence why it was denied
Good luck to you. Keep at it b/c eventually they will see that you need it and sometimes you just have to go through the motion. Good for you for trying to stay healthy.
Appeal YES give up NO… Back in the day I my A1c was 12.9 my cpeptide was .9, the cpeptide is the kicker, anything above 2.5 is auto denied, anything below 1.0 is approved. Medical documentation is strongly encouraged. When I was MDI I was taking seven injections in just ONE day!!