View Full Version : What would you do?
Bsbllmom
03-11-2008, 11:19 AM
Ok I finally have tight control of Christian's D. So yesterday our CDE called to tell me that the sleepover is cancelled:( So during the conversation I told her how good Christian's #'s have been since out last appointment. She said not to get it too good because when they send in for pump approval they might say he doesn't need it because we have such good control with MDI. :eek: Is that possible? Can they do that? So what do I do? I can't just let him run high and low just because. So WWYD?
Abby-Dabby-Doo
03-11-2008, 11:32 AM
You care about Christian, he is your main concern, so take care of Christian first and foremost!
This isn't the first time I've heard "when they send in for pump approval they might say he doesn't need it because we have such good control with MDI"- I think your chances of hearing that the pump was denied are small. Even if that did happen, you just APPEAL, APPEAL, APPEAL. You have too many other things that can throw that "good control" off track to fight with. Puberty, illness, and hormones just to name 3!
taximom
03-11-2008, 11:42 AM
We were just approved for a pump and were not really having any major problems with my DS's numbers. If your endo wants you to get a pump, they will fill out the paperwork accordingly. I would not "create" bad numbers, just to get a pump. There was a long list of issues for the endo to check off that determine medical neccessity. And actually all or most of them apply to my DS at one point or another (probably for all of our kids).
Some were as basic as "hypoglycemia", etc....I can't think of the others right now. I'll try and find my paperwork.
GaPeach
03-11-2008, 11:54 AM
She said not to get it too good because when they send in for pump approval they might say he doesn't need it because we have such good control with MDI. :eek: Is that possible? Can they do that? So what do I do? I can't just let him run high and low just because. So WWYD?
Read my "Good / Bad Endo" Post http://forums.childrenwithdiabetes.com/showthread.php?t=12959
Our A1C improvement may mean - No Pump!
momandwifeoftype1s
03-11-2008, 12:02 PM
This to me makes as much sense as when I called the insurance company for my husband (T-1) to ask if they would pay for a nutritionist/dietitian for him. Nope - no coverage. I asked "Would you pay for hospitalization if he had a leg amputation because he didn't take care of himself". Yes, they would pay for that. Huh? So, no preventative care to avoid complications? We had to pay out of pocket for that. I think that's crazy!
twodoor2
03-11-2008, 12:09 PM
Our insurance makes us pay for all preventative care for our kids, that means all routine checkups and higher priced vaccinations (the lower priced ones are covered by the state). With 3 kids, this is a lot of money, and with the baby, since they go for checkups every month, it was over a thousand dollars just for him the first year. However, they will pay for my routine care with the gynecologist. :confused:
Hollyb
03-11-2008, 12:15 PM
It's the Catch-22 of diabetes: in some cases, you can't get a pump approved unless you have a high A1c to show that you can't get good control without it. In other cases, endos won't approve a pump until you have a good A1c... huh????
Bsbllmom
03-11-2008, 12:51 PM
You would think just the fact that it gives more freedom and helps control their #'s even more would be enough. I would never create bad numbers just for the sake of a pump. I know that with him being 12 we are headed for a rough ride with hormones, growth spurts, hunger, emotions and whatever else is out there. So I am hoping that they can get it approved the first time. A pump should ALWAYS be approved what are these insurance companies thinking?:mad:
vettechmomof2
03-11-2008, 12:57 PM
You would think just the fact that it gives more freedom and helps control their #'s even more would be enough. I would never create bad numbers just for the sake of a pump. I know that with him being 12 we are headed for a rough ride with hormones, growth spurts, hunger, emotions and whatever else is out there. So I am hoping that they can get it approved the first time. A pump should ALWAYS be approved what are these insurance companies thinking?:mad:
Our insurance says an A1C above 8. Luckily we were still at 8.4 at the time paperwork was submitted.
Allene
Bsbllmom
03-11-2008, 01:04 PM
Well our last a1c was 7.1 and our CDE said that she doesn't want to see it higher than that. So now I am keeping it below and she said we may not be approved.:confused:
It's the Catch-22 of diabetes: in some cases, you can't get a pump approved unless you have a high A1c to show that you can't get good control without it. In other cases, endos won't approve a pump until you have a good A1c... huh????
Just what I was thinking!