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Thread: A1C Too Good For A Pump

  1. #1

    Default A1C Too Good For A Pump

    Do insurance companies really deny pumps when A1Cs are under 7? We have Anthem and one of the criteria for pump approval is having an A1C over 7. Sophie currently has an A1C under 7.,We are managing D well-ish at this point,but she wants a pump to be able to live more normally and not have to choose between eating as she likes or taking another shot. Lately she will refuse to eat even if she is hungry,because she doesn't like the shots
    Sarah mom to
    Ian 13
    Sophie-11 dx Nov 6 2012 TSlim G4
    Taci 7
    Leah 5

  2. Default

    Quote Originally Posted by wearingtaci View Post
    Do insurance companies really deny pumps when A1Cs are under 7? We have Anthem and one of the criteria for pump approval is having an A1C over 7. Sophie currently has an A1C under 7.,We are managing D well-ish at this point,but she wants a pump to be able to live more normally and not have to choose between eating as she likes or taking another shot. Lately she will refuse to eat even if she is hungry,because she doesn't like the shots
    My guess is that she might still be honeymooning and that's why her a1c is 6.2??

    Maybe a letter of medical necessity might offset the a1c criteria?

    It stinks that she hates shots that much that she doesn't want to eat . Mine doesn't mind them at all. We went off the pump to go back to shots recently.
    Kristen

    Mom to
    DD 5: 10/11/2008- diagnosed 3/31/09 at 1.5 years.
    3/31/09- 01/2012- Humalog and NPH
    01/2012- 04/18/2013- Humalog and Lantus
    04/18/2013- Pumping with a Pink Animas Ping
    09/13- back to MDI with Apidra and Lantus

    DS born July 29, 2013

  3. #3

    Default

    she isn't bad about it,but she doesn't like it either. I can't say I blame her,for almost 11 months she has had at least 4 a day. I think if I were in her position I would choose not to eat unless I was starving too
    Last edited by wearingtaci; 09-29-2013 at 02:10 PM.
    Sarah mom to
    Ian 13
    Sophie-11 dx Nov 6 2012 TSlim G4
    Taci 7
    Leah 5

  4. #4

    Default

    Our insurance company had that criteria too and my son's A1C was 6.7, they approved us anyway.

    We didn't fit all of their criteria including having problems with Dawn Phenomenon and having been diagnosed for 6 months.

    I would go ahead and try for it if you want it, you'll never know until you try.
    Mom to 3 boys:
    Tanner 5 D'xd 2/1/2013 - MDI Humalog and Lantus 2/1/2013-7/8/2013
    Pinging with Green Animas Ping 7/8/2013
    CGMing with Dexcom G4 since June 13 2013

    Spencer 7 , and Romney 9

    "Sometimes superheroes reside in the hearts of small children fighting big battles"

  5. #5

    Default

    Sometimes all that is needed is a Prior Authorization - a statement by her doctor that the pump is medically necessary for her. I would think that her refusing to eat would fall into that category. That's the angle I would use, anyway, if all else fails!
    ~ Wendy ~
    Wife to a Good Man and Mom to Seven Way Cool Kids, Ages 17, 15, 13, 11, 9, 6, 4
    Elizabeth, DX'd 5/26/09 - Type 1 at age seven

    Pinging Blue 11/9/10
    Dexcom Seven Plus 6/15/11
    Dexcom G4 7/31/13


  6. Default

    Quote Originally Posted by wearingtaci View Post
    she isn't bad about it,but she doesn't like it either. I can't say I blame her,for almost 11 months she has had at least 4 a day. I think if I were in her position I would choose not to eat unless I was starving too
    I almost wish sometimes I had to jump through hoops to eat, it would be easy to diet then!! lol, but back to the point, my daughter will be 5 next month and has D since 17 months and we only pumped 5 months. She's a humongous pig though and doesn't care at all if a shot is what it takes to eat.

    Definitely try to get a letter of medical necessity, it really could be all you need.
    Kristen

    Mom to
    DD 5: 10/11/2008- diagnosed 3/31/09 at 1.5 years.
    3/31/09- 01/2012- Humalog and NPH
    01/2012- 04/18/2013- Humalog and Lantus
    04/18/2013- Pumping with a Pink Animas Ping
    09/13- back to MDI with Apidra and Lantus

    DS born July 29, 2013

  7. #7

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    We had anthem when Ashleigh got her pump. I can't remember the exact A1C but i know it was below 6.5%. As far as i know there was no issue getting a pump for her.
    Chris mom to 15 year old Type 1 daughter DX 3/23/10 pumping animas ping

  8. #8

    Default

    With an appeal to a rejection (if they do indeed reject) you should get it approved with your endo's letter of medical necessity. Don't give up if this is what you want!
    mom to Molly, 21, dx 7/9/10
    Pumping with Animas Ping 11/10
    Dave, 24, non D
    Wife to Bob...great guy!!

  9. #9

    Default

    Quote Originally Posted by obtainedmist View Post
    With an appeal to a rejection (if they do indeed reject) you should get it approved with your endo's letter of medical necessity. Don't give up if this is what you want!
    I'm perfectly happy with MDI.Sophie wants a pump and it is her diabetes and her choice.
    Sarah mom to
    Ian 13
    Sophie-11 dx Nov 6 2012 TSlim G4
    Taci 7
    Leah 5

  10. #10

    Default

    Quote Originally Posted by wearingtaci View Post
    Sophie wants a pump and it is her diabetes and her choice.
    That's a fabulous reason to get one!
    mom to Molly, 21, dx 7/9/10
    Pumping with Animas Ping 11/10
    Dave, 24, non D
    Wife to Bob...great guy!!

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