Wal-Mart Insurance will not cover a pump!

I’m a bit shocked and confused with my insurance coverage as a Wal-Mart employee in Canada. I’ve been denied an insulin pump. They will continue to cover my pump supplies but tell me I’m not eligible for an insulin pump - ever!

I’ve been a pumper for 8 years and am currently trying to get the MiniMed Paradigm with the CGM. What Manulife is telling me is that Wal-Mart has just made a revision in the last few weeks and took the pump off the eligibility list?? My doc has written the letter already and they still have denied it.

Anyone ever dealt with something like this? I appreciate any help & advice.
(I did search the forums and I believe my searching skills suck)

Not all insurers cover insulin pumps.

What the insurer will or will not cover is determined by the insurance contract / plan text that the insurer puts together for the employer. The insurer takes instruction on what to cover or not cover directly from the employer. At times, employers change the specifics of what will or will not be covered at renewal with the insurer. And why? Usually in an effort to keep a lid on healthcare benefit costs.

That being said, if this was a recent revision to the plan text to drop pump coverage that was previously in place, I would seek MimiMed’s help to look into the situation in greater detail with your employer. When specifically was the group benefits policy changed? What was the effective date of the change? What allowance can be made for an individual who was in the proceess of applying for pump coverage before the change, etc. Keep in mind that if the coverage existed before, and is now no longer available, this was AN employer driven change, so something to take up with Wal-Mart’s H.R. department for reconsideration.

Do you have an employee booklet that indicates coverage for insulin pumps?

Did you receive information from the employer notifying you of the pending change?

You might be able to argue your way to a pump approval if your employee booklet indicated the availability of coverage that has since been taken away, without any notice to you as an employee.


If you have a pump now and the insurance covers supply, you’ll probably have that pump for awhile.

Not all insurers cover pumps. They generally have their own internal rules, not written in the contract, about when they’ll cover a pump.

Furthermore, getting a new or replacement pump is not the same as continuing with your current pump in “InsuranceLand.” There are all kinds of rules governing ‘continuation of benefits’ when an employer changes insurance plans, but they differ from state to state in the U.S. and I have no idea how it works in Canada. But in “Insurance Land” continuing to pay for your supplies could be continuation of coverage but replacing the pump - not.

I’m sure there is either a labor department or insurance/health care department at the local or provincial level you can contact to get more detailed insight. Don’t rely on searching tuDiabetes or the Web. You’re going to have to dial the phone and use some shoe leather, I think.


Thanks for the replies.

This has been a battle for about three months now. Lots of verbals saying that I’m eligible for a new pump (even to Medtronic) and as of recently this week, I am no longer eligble since the policy has changed. Granted, I do blame myself for not getting them to send me something in writing saying I am eligible. I’m hoping Medtronic has something in writing from them at least.

It’s been a ton of back-and-forths with A1C requests, doc’s letters, manulife telling us they have no records of phone/fax contacts etc… We never had this before with the last two pumps. It was simple before. We have recently changed our policy with Manulife though in the past 6 months, but regardless it makes no sense anymore.

I have my hubby looking for the old policy book right now to see if it is stated in that since we did not receive a letter from Walmart informing us of a policy change. HR could not answer this question and we’ve been waiting on them for an answer now for a week. All we received was the new policy book on Wednesday -that is all.

It’s very frustrating. I find it odd that they will cover the new pump supplies but not the pump.

I do a lot of third party administration work in group benefits for a large association. As a third party administrator, I am often required to act as a conduit between the employee/member and the insurer for the association that we represent.

It is not unusual for an insurer to cover insulin pump supplies (which by the way, does not extend to CGM’s) while not covering the actual pump. The policy I work with, is exactly like that. It does not provide coverage for a pump, but does cover infusion sets and reservoirs for anyone who goes out of pocket to buy a pump. It does not cover anything to do with CGM’s. Not the $700 transmitter that needs to be replaced every other year and not the $50 sensors that need to be replaced every three days. My husband’s plan is through a different employer and insurer. His plan was going to cover all but $1,000 of the $6,500 needed a few years ago for a MiniMed pump for my son. In the end, the insurer did not have to fund a pump at all, as the Ontario government put initiatives in place to make healthcare funding for pumps available to all T1 children through the assisted devices program of the department of health and long term care.

What I found confusing is that it appears you had pump coverage in the past and now do not. If this was a change made by the employer, change of carrier, or change to policy at renewal, that is fine, the employer is entitled to change carriers or change the policy, but if the change occured while you were doing the back and forth on an approval that would have been granted had the employer not made the change, then you can argue that coverage should be extended and your employer does have the ability to extend coverage as a one-off. Your fight is with your employer, not the insurer and you may get help from your employers H.R. department or group benefits specialist, so find out who that is.

The insurer simply follows the plan design and plan design rules, that your the employer puts in place.

I would definitely address the coverage denial if it is due to a recent change, particularly if a back and forth for approval was underway before the change. Please don’t take this personally, but your employer may argue that you have already been extended more than sufficient coverage if your employer paid for your last two pumps in the past 8 years. I can understand wanting to keep up with the most recent technology in an effort to reduce ones A1C, but one can’t expect someone else (i.e. employer) or in our case the government (so all Ontario taxpayers) to pay for the newest thing out there.

You will definitely have a fight ahead of you, but one that may result in another employer funded pump. So get cracking. Find the employee handbook. Find what the reconsideration period was on the last approval for a replacement, etc. Find out what changed, when it changed and get documentation of when you started your approval process and push, push, push.

Two years after making pump funding available to all T1 children, Ontario moved forward on making pump funding available to T1 adults as well. This initiative was the result of an in depth study that showed the Ontario government that the cost to society would be less to provide a pump and an annual grant for pump supplies to promote good diabetes control over the cost to society to take care of a T1 with diabetes complications. By the way, the Ontario grant for supplies, requires an annual endo certification that A1C’s are less than 10%, DKA has not occurred more than once over the past 12 months, effective pump management has been proven by the patient and appointments (a minimum 3 clinic visits in 12 months) are attended.

You will have to be your own advocate on this pump initiative. Are Wal-Mart employees unionized? If you are, that is another source to go to for help.


Desdemona ,

As a point of interest and possibly good timing, if one can call it that , Heather Burt has 2 recent postings on the Canadian site …her posting somewhat different as she is discussing CGMS , but maybe worth visiting her discussions .

What I always have understood and I think Cheryl covered this aspect as well about my Extended Health plan will cover for a new/replacement pump , if the present one gives up the ghost , NOT because I like to get the latest gadgets . I have always upgraded , when possible , Medtronic user since 2001 and paid for the upgrades out of own pocket .
Now comes tax time …you probably are aware: : Line 330 of the General income Tax and Benefit Guide…" generally you can claim all amounts paid …your total expenses have to be more than either 3 percent of your net income or $ 2,011, which ever is less "
Is your present pump not in proper working order ??

Another on the side …there is also a discussion about DTC ( disability tax credit ) on the Canadian site

Ontario started a pump funding initiative for T1 children about three or four years ago and within the two years added pump funding for T1 adults. This is a provincial initiative and is not Canada wide. Healthcare here in Canada is a bit of a mixed bag. I work in the group insurance industry, yet were it not for my husband’s employer (school board), I would not have group insuance myself as my employer is not part of the group plan that we look after.

I have heard parent groups of T1s joke about telling their kids that they need a good, job in the federal government when they finish school to be sure that they have employer paid health insurance. When this discussion went around the table in general conversation at a JDRF meeting, it was discussed, that promoting the federal government as the employer of choice for a T1 is not quite good enough for the long term. You now need to work for the federal government and be married to someone from the federal government and KEEP both sets of benefits in place, as there is a lifetime limit on diabetic supplies that will not carry your just out of school T1’er who goes into federal government as a lifetime career choice, into retirement. He or she will need the benefit of the lifetime maximum from both plans to make it to retirement.

A little bit of sarcasm, with a lot of truth to it, Tom.


Great info! Thanks

Geez, too bad we don’t live in Ontario anymore! That is great for Ontarions. I’m happy all that is in place finally.

Yes, it seems like the battle is going to be with Wal-Mart. I totally get the Manulife side of this. We’ve been with Manulife for almost 10 years and I can only say positive things about them, however we did just recently make a change in the past 6 months (changed employers, hence switched policies) thus this is the reason for the hard time we are facing at getting the new pump.

My current pump is still good and is now 4 years old. I’m a happy gal with it, however we have been planning to have our first child and our Endo is strongly recommending the CGM with the pregnancy. I don’t mind spending the extra $1200++ for this new pump, since our insurance did verbally quote that they would cover $6800 - 20% co-pay fee etc…

The Wal-Mart is not unionized. I think, I could be wrong, but there is only two unionized Wal-Marts in Canada that I know of.

Thanks Nel.

I just read her blog. Now I’m worried! I never even thought about the CGM supplies. I’m sure Medtronic included it in the quote they sent for the pre-approval. (which was denied)

Yup, fully aware of the tax credit and I usually get it every year. As for the DTC, I’ve yet to ever apply for it. I’ve done some research and I may actually attempt this, this year.

Thanks again.

I wonder is this would be feasable.( sp?) for you … finding out from Medtronic the cost of the Guardian Real Time /CGMS …or can the endo set you up for 3 day stints over a certain time , till you decide to go for the MM pump ?..just thinking out loud …yet I maybe totally off .

I like the thinking out loud!

Ok, mind my noobness, but is this CGM a stand-alone? like the dexcom? I only ask, since I have a Animas pump right now. It would be nice to have it all in one system, but if that can’t happen, than I’m game for two devices sitting on my belt.

Googling Guardian Real -Time will get you there ; yes it is a stand-alone …the " gadget " for lack of better word at this moment looks simelar to the MM pump .

Tom – Not sure if you’re teasing or not. But in Canada, basic health care is covered through the public system – doctor’s visits, emergency care, surgeries, those types of things. We have employer-sponsored or individual insurance coverage for all the rest which includes prescriptions and medical supplies, dental care, vision care (seeing the eye doctor and glasses/contacts), and paramedical services (like chiropractics and massage therapy). Our public health coverage is governed by our provinces, so something that is “free” in one province is not in another. To my knowledge, most provinces don’t cover for pumps for adults.

Pump and CGM even though they are one system the sensors and transmitters are usually not apart of the price qoute unless your doc wrote for both. mine didn’t remember but minimed called him and he wrote for it and I had no problems with getting both I am sorry to hear you are having so many problems it stinks we have to fight for our health.

FYI : I received this past week a brochure from Medtronic( for the Canadian audience ) …mentioning 3 offers : 1) CGMS package with purchase of pump,incl Minilink transmitter and 8 glucose sensors , $ 299.00 , 2 ) Carelink package with purchase of pump , incl.Carelink USB and laptop computer $ 299.00 OR choose both packages for less than $ 600,00 3 ) Free box of Bayer Microlet coloured lancets…call 1.888.858.6943.

I also asked about the Revel Pump …and was advised by someone else from MM . , that Health Canada has to approve ; MM does not know, when available in Canada …could be soon , could be later .
Yes, go for the DTC…I learned today from a TU member : the person will need to re-apply in 2015, after the credit was received this week …I say WHOOPY , as I had to re-apply after 2 years ( 2006…I think ) .


I am still trying to figure out how we are going to apply for the DTC as David’s endo will not sign. I printed the template from the Sudbury TU member whose clinic is promoting the DTC for all diabetic patients of the clinic, but David’s endo said the clinic is lying. Yeah David does not spend so many minutes a day looking for air bubbles, but he does do a minimum of 6 day time BG readings and I add at least one overnight. Yeah, a reading might not always take five minutes if you skip handwashing, etc. But handwashing is not supposed to be a some time thing, it is supposed to be an every time thing.

David was approved for the DTC to age 16. At that point since January 2009, he was supposed to miraculously be able to manage ALL of his diabetes needs by himself. So parental time, no longer counts. I have done and continue to keep his daily logs. David was diagnosed with a reading, writing, math, learning disability in his primary years. Someone has to keep the daily logs and if I don’t, the exercise would not only take more than two hours a day, but would also cause a great deal of strain on a teenager who is already maxed. The endo’s point of view is that, leaving the logging detail to the parent is typical of a 17 year old and not really at all diabetes related/relevant.

I know I am off topic here, but this DTC business is really bothering me. The DTC should be available across the board for all diabetics. I don’t belittle others illnesses, in saying this, but I have a family member who is legally blind. She was approved for the DTC as a child and will never have to re-apply. She does not have to show any time commitment to dealing with blindness and while she is legally blind, she can see well enough to be able to read a text message on a cell phone. She is a college student. She can see well enough to work independently on a laptop computer and her school books are reprinted and bound, free of charge in an enlarged print format. She is disadvantaged in that no matter, what she wants, she will never be licensed to drive a car and she needs breaks in her school work load to manage the strain of trying to read over extended periods of time.

So how is diabetes different, in qualifying for the DTC


In Ontario, we have always been covered for surgeries, treatments, medications, therapies while in hospital, Dr. visits including all Specialists, therapy in outpatient Rehab center, theraputic shoes for specific foot problems, etc. This is covered by a small monthly tax from our wages.

Paramedic’s Service and Ambulance is $45. for each use.

Drugs are not covered here unless someone is eligible for Disability, Welfare because of job loss or on Senior Pension Plan. The Ontario drug program is also helpful in assisting with getting medications, if a Person does not qualify for the others(Disability, etc.) mentioned. Most Drs. also give free samples of some meds. and meter kits(Endo’s), if you ask. Pharmacies give free biohazard sharps containers, if you ask.

When I was on Disability, I had weekly visits from the Social Worker to see if I needed help with anything. I also had a Homemaker twice a week to help with the Kids, personal care and housework. The Arthritis Society also gave me Physical and Occupational Therapy 2x weekly.

Insulin and pumps and accessories are free here except for a $600. fee which can be covered by the Person or their Insurance.

My Hubby’s Insurance covers all of our meds. and covers the pumps and accessories(last I heard) for $35.00 a year.

There’s more but I thankfully haven’t needed it. Provinces and Territories differ in Healthcare.

Not a bad offer at all. Do you know the deadline by chance?

I will speak to my rep about this for sure since the CGM package looks very appealing.

Thx for the info

Cheryl ,

Are you willing to add the above comment to the Canadian discussion on DTC as well ? You may get more responses /suggestions …I have a sense the suggestion likely will be to get to see a Doc , who will sign and who will not push his/her judgement for the 14 hours weekly to be covered.

In fine print : Offer expires April 30, 2010
I wonder too , if the deal is posted on the Canadian Medtronic site ??