I do. but I think they do it to protect their bottom line moral judgement don't play into it. oh well either it stinks for the patient.
Maybe maybe not regarding the fight for a pump. I didn't have any problem with my insurance approving my for pump 81/2 years ago. I'm pretty sure my doc never had to submit a C peptide either. Medicare is the one with the C peptide requirement many insurances accept other indications such as all those BSC noted in his post.
For a while I was denied CGMS coverage because I'm type 2. I resubmitted for CGMS at the same time I got my new pump and was approved despite my type 2 diagnosis.
Talk to your endo. Mine has a lot of type 2's on pumps and so do others in the area. I asked because I wanted to get an idea of how much overall experience they had with it.
Type 2 diabetics can get insulin pumps you just have to fight for them a lot harder than a type 1. I got a pump being a type 2. I had to fight for it for almost 2 years before I got it but I did get it. Since then I have been rediagnosed as a type 1. My endo did not do a C-peptide test until after I was on the pump.
Contact the insurance company to see exactly what the policy covers. My husband's company let it slip that they covered all diabetic supplies. If they do not exclude pumps for diabetics then I would have the doctors write another letter of necessity. If they deny the pump again go to the HR department. If both parents work then that may be the issue. Each one of the insurance companies are trying not to be the major carrier.
Keep fighting no matter what! It is well worth the fight. Make sure that your endo is willing to keep writing the letters. Each time you go see the endo have them write a new letter. Send in a copy of the glucose testing. Make sure that your endo is very descriptive on why they want your child to have a pump. Have your endo send you a copy of the letters each time they send one to the insurance company. I saw the letters that my old endo's sent and they read like it was not that I needed a pump I just wanted one. If your endo is not willing to do the work switch endos.
After switching doctors a number of times I am happy to say it was well worth the fight and I would do it all over again in a heartbeat.
I was averaging 8 to 12 shots a day before the pump. That should have said something to the insurance company.
I am very confused... because on your profile, you mention that your daughter is Type 1... but yet this discussion is about Type 2, and you talk about your daughter's not being able to get a pump... I know more and more kids are getting Type 2... but I just want a little clarification :D Thanks!
Hi I’m a “thin” t2 at 110 pounds and a size 4. I also have to use insulin. I’m on two different kinds and several shots a day depending on my numbers. I didn’t realise that insurance wouldn’t cover pumps ?? That’s awful? You should ask for a letter in writing exactly why they are not covering for you! Don’t try to guess because God knows it could be anything. Id ask exactly what cretieria you would have to meet to get covered also id get that letter of explanation as to what reason there not covering once you find that out then maybe you work with your doctor to see if you meet the criteria. Sometimes its all paperwork and knowing what to submit. Good luck to you and id take the first step and ask for a detailed reason in a explanation letter of exactly why they denied you? Does your doc think its a good idea to have a pump? Maybe he can write a letter in your behalf of why its necessaary for you? Id ask my doc.personally I use a 24 hour insulin along with another insulin and that works well for me. Good luck to you!
This sounds like you need more like you need to switch doctors. I went through several doctors before I found one that was willing to do the paperwork. She ask me what I wanted from her at our first appointment. By the third or fourth appt. I was on a pump. I just fired a doctor that told me that he does not have time to do my paperwork. I do not have time for him then.
Pump companies are actually starting to seriously market their pumps towards Type 2s. The Minimed pumps, especially, have come out with really high basal rates (dozens of units an hour) and really lows bolus and correction ratios in order to be more usable by people with type 2s. I've heard stories of type 1s having to jump through all sorts of hoops to get pumps, and I've heard of type 2s who have gotten pumps with relatively little fuss.
Some one wrote that they were confused about my daughters diabetes. What's the confusion, you either have or not whether it's type1 or type 2 the ending battle is equally the same in the long run.
Actually, if you scratch below the surface, there is terrible confusion about typing and diagnosis. Consider this:
The "gold standard" of type 1 diagnosis is antibody testing, yet apparently only 85-90% of type 1's test positive.
More like a bronze standard.
Absolutely... I agree. I wasn't meaning in any way to belittle her experience, or yours. I am a Type 2, myself, and I have no prejudices as to whatever type of Diabetes someone might have. I just wanted to get a better grasp of the situation. If you don't want to say what type she is, that's fine. That's your choice. We are all just here for support.
It wasn't that... I just didn't know what type she was, from this discussion, as it's not very evident or apparent, and THAT was confusing... I kind of like knowing what type someone is before giving advice ... I don't want to say things that won't apply or help. You know what I mean?
How did you get so thin??? This is not fair. I think I was 110 from the waist up in high school. its been down hill every since.....
Thanks, but I guess even if you knew the claimed diagnosis, there is a big chance it is "wrong." The same thing can be said about a claimed T2 diagnosis, about 20% of diagnosed T2s are actually antibody positive.
Fine, split hairs about it... :P But the confused person she was referring to was ME... and not some doctor not knowing how to diagnose.
Pumps are not used usually unless the C-peptid shows a big change in the amount in Insulin secreted ( meaning less and less ). This is especially true for Medicare Guidelines. Thus, making it private pay all the way for the pump. That's what happened to me. C-peptid is not done before the pump is given or when we ask for the pump by most Endo's or PCPS'.
Insurance companies don't want to give pumps to Type 2's because there are so many of them, and then the insurance company's expenditures for medical care would go way up, and cut into the profit margin. Medical care insurance for profit is SO WRONG!! And that's what makes it a moral issue. Insurance companies are in it strictly for the profit, and the way they make a profit is to deny medical care. Period.
I once read an article somewhere that said that non-profit organizations like Kaiser actually provide better care, and have fewer bad outcomes.
As far as a Type 2 getting a pump, your best allies are your doctor and the pump companies. They work hard to make a sale and they really want to help you.
Good luck!
Type 2's can get pumps, and depending on their c-peptide levels and how they have managed their glucose. If they are insulin dependent and take multiple shots a day then they can qualify for a pump.
I think approval is going to be different for each insurance company. I am a type 2 on an insulin pump and cgm. I didn't have a problem getting on the insulin pump but had to fight for the cgm. I fought hard until I won and I am darn glad I did.
I can understand your frustrations. I had to fight and appeal to get my insulin pump (this was 5 years ago).
Regardless of the insurance companies decisions, it sounds like your daughter has GREAT blood sugar control on injections. Congrats to you and her on that!! Her control may not improve on a pump. If I was able to keep an A1c under 6 on injections, then I don't think that I would use the pump.
I understand that she is sick of injections, but in many ways, I think that the pump is harder than injections (you have to wear it 24 hours a day, change the infusion sets, check your blood sugar more often). When I switched to the pump, I was not diligent about testing often (meaning 10 times a day or more) and my A1c actually got worse on the pump. It's a lot of work to get the settings right in order to experience better blood sugar control on the pump. I'm not trying to discourage you from doing it. I just think that often people who are not on the pump imagine that life on the pump is so wonderful! I actually don't think it's that great and the only reason that I put up with it is that I get better blood sugar control.
Have you considered using i-port until you are able to get a pump? This is something that you insert into your skin (like the infusion set on a pump). If your daughter finds the injections painful or annoying, this might help. For the group on TuDiabetes about I-port, click here