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Denied Pump bcs of ADHD (rant!)

Discussion in 'Parents of Children with Type 1' started by sheila1128, Mar 12, 2012.

  1. sheila1128

    sheila1128 Approved members

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    So frustrated and angry! :mad:

    The insurance company denied Riley's pump because "he is not independent with his diabetes care. He has only been diabetic for 6 months and it is not clear that he fully understands how to manage his insulin doses now because others are managing it for him."

    I called his doctor's office to see what their position was and if they knew about the denial. They did and are gathering more info to send, including a peer to peer discussion between his doc and one of their docs if necessary. I am blessed to have someone to help me fight. The person I spoke with said that one of the reasons they used was that he has ADHD and might not have enough control to manage it. I am sooooo angry! My son didn't choose to stack diabetes on top of his ADHD. However, he manages his ADHD well and it does not interfere with his life - we won't let it. Just as we have meds to help keep the ADHD in his pocket, we want to get him on the pump to help keep the diabetes in his pocket. How dare they discriminate because he has ADHD!!!!

    As for managing his diabetes independently??? He tests his own blood sugar, calculates his correction, calculates his meal bolus, draws up the proper amount of insulin and gives it to his dad and I to inject. The only thing he isn't ready to do is inject himself - and this is after only 8 months! Aside from a few "I don't give a rip if I have diabetes" moments, he is my hero as I don't think I, as an adult, would have handled the changes he has had to so gracefully.

    I know I am preaching to the choir. I was not surprised that he was denied and that I need to submit more paperwork. However, the reasons for denial are completely unacceptable. While the doctor's office gathers information, so will I. I am contacting his psychologist and psychiatrist tommorrow for them to write a letter regarding ADHD and how it would not interfere with him learning and using an insulin pump. I am also going to send the papers with his numerical calculations to figure his doses. I will choke them with paper if that is what they want.

    Thanks for letting me rant ... sometimes it is just cathartic to get it out in some form or another!
     
  2. cockatiel

    cockatiel Approved members

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    So sorry! Your doctor sounds like a gem, and I hope permission is granted soon!
     
  3. buggle

    buggle Approved members

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    Babies have pumps. You don't have to manage D yourself to use a pump, so their lame attempt at discrimination has no basis in reality.

    I'd fight them on this one. If your insurance has pump coverage, I'd contact your state insurance commissioner to file a complaint.
     
  4. StillMamamia

    StillMamamia Approved members

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    So, all the children 10 and under, including babies who were put on the pump, were fully independent with regard to their D-management:confused: This kind of crap pisses me off. Pardon my French.

    I'm so sorry. I hope a solution is found.
     
  5. mom24grlz

    mom24grlz Approved members

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    That's about the stupidest excuse i've heard as to why someone should not have a pump. Like a previous poster stated they give pumps to infants and toddlers. Do they seriously think those children handle their own pumping needs.
     
  6. Mish

    Mish Approved members

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    And they give pumps to ALLLLL sorts of parents and they never question their intelligence or capability.
     
  7. Mommy To 4

    Mommy To 4 Approved members

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    So sorry you are dealing with the insurance BS. My daughter's primary insurance approved her pump and CGM within a few days, unfortunately, Medicaid, which is secondary have denied her twice now. First because she hadn't been diagnosed for 6 months and now because her BG was over 200 when they drew her c-peptide. Yep, she has diabetes, what did they expect? It seems that insurance companies will do whatever they can in hopes of frustrating us to the point that we give up and go away. Good luck. Hopefully your endo will get it taken care of for you.
     
  8. deafmack

    deafmack Approved members

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    That sucks. ADHD has nothing to do with D. Your son is doing an amazing job of managing his own D for only having it for 7 months. To day that he can't use an insulin pump bcause he has ADHD is one of the dumbest reasons I have ever seen. Don't give up. Let your son know that we are here for him and you as well. The reasons one gets for not being allowed something just blows my mind sometimes.
     
  9. selketine

    selketine Approved members

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    Back when William was put on the pump (2004) it was still the position of many doctors/clinics that children shouldn't be put on a pump until they could manage it independently. You can find literature back then from respected diabetes centers saying that - they have since changed their tune of course.

    Sounds like your insurance hasn't moved forward if they REQUIRE independent pump management.

    I can theoretically understand concerns about ADHD and having a child completely self-manage (my older child who doesn't have diabetes is ADD). It seems with proper parental oversight this wouldn't be an issue - no more so than for younger kids who cannot self-manage.
     
  10. betty6333

    betty6333 Approved members

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    Yup, that is stupid. Kids don't need to understand how to use the pump. The parents usually do it for them until they are old enough. There is even a lock out feature so the kids CAN'T touch the pump and only the parents can get in to dose and change settings.
    My son started on the omnipod at age 6, and one HUGE feature for us was I carried the pump and did all diabetes related care. All he had to do was wear the pod, and he couldn't mess it up even if he tried because he didn't have access to the buttons. My son also has ADHD, but he never doses or messes with his pump...
    It sounds like your insurance is giving you the run around.:mad:
     
  11. bibrahim

    bibrahim Approved members

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    definitely appeal. I hope they change thier minds. Bummer is that it takes a long time for the appeal to be processed and in the mean time if you are like me you get stressed over it. Use that stress and energy to write a strong appeal letter with lots of examples of his independence with D care.

    Send spread sheets with his numbers/carb counts/exercise/foods chosen, etc. Like you said, kill them with paper.

    Use blue highlighter for lows, red for highs, etc. Show them that you know what you are talking about when it comes to D care.

    If you see lows at certain times of day or lows that you have to "feed the lantus" at certain times, stress that he has different basal needs at different times of the day and you cannot fix that on lantus. Talk to them about his exercise and how a pump will benefit him in that area (being able to set temp basal rates). If he is overweight show them how fixed snacks for lantus are not helping him. If he is normal weight think of something else to say. Basically feed them a line for every line off bull they feed you!!
     

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