Showing posts with label insurance problems. Show all posts
Showing posts with label insurance problems. Show all posts

Wednesday, March 28, 2018

The Three Little Pumps

Once upon a 2018, a Type 1 like myself had three pump choices...

Pump A: Tubeless. Doesn't hold enough for my insulin needs. A big no.

Pump B: My current brand. I like it, but I've never loved it. I may have lied and told someone that I loved it. It has some physical problems that have happened to me consistently, causing me to have traded my pump in at least 3 times before my warranty expired. The physical issue means that I have to have assistance with changing my cartridge. My hands are not strong enough to slide the cartridge on or take it off by myself--I usually have Matt do it for me. I want to avoid this problem in the future (and will blog more of the specifics at a later date).

Pump C: The brand I first used when I got my first pump in 2000. I don't have anything against them. Have I loved everything they've made? Meh. But I am ready for a change, and I know their CGM is no longer inferior to the other one I've used. I didn't expect to get static from my insurance company in trying to get this pump approved, mostly because I've gotten other pumps through the same insurance since Matt has been working at the same company for 10 years. I remember needing some pre-auth stuff, but I did not expect my insurance to go through 2 rounds of pre-auth and a consultation with my endocrinologist to prove my pump was "medically necessary".

Am I trying to prove a point here? Is this one of those "idle chatter" types of blog posts? Maybe a little of both. I have Type 1 Diabetes. I think that is enough of a medical necessity to acquire an insulin pump. The end. 

We used to have what, 5 or 6 choices of pumps at one point in history? And we all need insulin to survive, and studies show many people have tighter glucose control on pumps. I wish I understood more about the nonsense that dictates the behavior of insurance companies. That's all I have to say for today.

Saturday, March 17, 2018

THIS JUST IN: Controlling Your Diabetes = Not Medically Necessary

CONTENT WARNING: Sarcasm ahead along with non-sarcasm. Good luck.

"Dear Member:

The purpose of this letter is to confirm that pre-auth [for your insulin pump with CGM] has been denied for the following reason(s):

Your provider asked us to provide a special type of insulin pump that can also continuously monitor your blood sugar. This was requested to help control your diabetes. This request has been denied as not medically necessary."


Neat! Did you guys know controlling your diabetes isn't medically necessary? Wow, what a relief. All this time I've been worrying about this garbage A1C that I have, but it turns out I shouldn't have to care at all.

Okay, in all seriousness, the letter goes on to explain they cover "these types of insulin pumps" for people with recurrent, life-threatening low blood glucose levels and also poorly-controlled pregnant women.

Maybe they would cover a pump without a CGM and a separate CGM system. I've never had trouble with pre-auth for Dexcom, surprisingly. Buuuutttt they would probably also say I don't need an insulin pump because my diabetes is poorly controlled in the wrong direction (highs instead of lows).

Just remember, kids, in the US of A we have the GREATEST HEALTHCARE SYSTEM IN THE WORLD where NOTHING IS EVER WRONG and PRESIDENT OBAMA RUINED IT FOR ALL OF US. It is sheer, tremendous, tremendous, big perfection.