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A1C Too Good For A Pump

Discussion in 'Parents of Children with Type 1' started by wearingtaci, Sep 29, 2013.

  1. wearingtaci

    wearingtaci Approved members

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    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
     
  2. missmakaliasmomma

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    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.
     
  3. wearingtaci

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    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: Sep 29, 2013
  4. Shopgirl2091

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    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.
     
  5. Lizzie's Mom

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    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!
     
  6. missmakaliasmomma

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    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.
     
  7. mom24grlz

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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.
     
  8. obtainedmist

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    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!
     
  9. wearingtaci

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    I'm perfectly happy with MDI.Sophie wants a pump and it is her diabetes and her choice.
     
  10. obtainedmist

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    That's a fabulous reason to get one!
     
  11. ChaosRules

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    Good for her and good for you. My son was diagnosed at 12, and one of the first things his pediatrician said to him was that it was ultimately his disease. We would all be here to help him, but he was the one who had to live with it, so the final responsibility would be his. That sounds like a lot to put on a 12 year old, but it was the perfect thing to say to my son, who is now 17 and takes care of his diabetes completely independently. I think at the time he felt proud that he was in charge of himself.

    At this point, I keep trying to be more involved in his care, and some days he tolerates that more than others!

    Anyway, back to your post, some insurance companies are more sticky than others about things like this. I think it's ridiculous that someone can be denied a pump (or a cgm) because they take care of themselves too well already. My son was in that same situation too, and after the denial, his endo wrote a letter and so did I. He did get approved at that point.

    We ran into the same deal with the cgm - he had to prove that he "needed" one by having a documented low below 50 that he was unaware of. Why couldn't he just get one because it should be standard of care?

    Go ahead and request the pump, and like others have said, if she's denied the first time, appeal. I agree that her refusing to eat would be a good thing to mention in the letter if you end up having to write one.

    I bet she'll get approved eventually even with her low A1c (and yay to her for that!). Pumps are pretty much standard of care anymore, and she has every right to want live more normally. She's right - it will transform her care!

    Good luck!
     
  12. Sarah Maddie's Mom

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    When we first submitted for a pump back in 2005 or 2004 we were denied, a bit of back and forth between insurance co and endo and eventually it was approved. I think pumps are far more common now - if by chance you are denied a careful reading of the letter and your endo practice's experience should be able to push back. There are many legit reasons to pump beyond A1c.;)
     
  13. SarahKelly

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    My son got approval for his pump due to his sensitivity to insulin at that time and his frequent lows. His doctor's letter of medical necessity stated that it was necessary due to the ability to better regulate basal rates and give small bolus amounts to meet his needs for insulin that we were unable to accurately measure with needles at that time. She went on to discuss the benefit of shutting off the pump during lows and how beneficial it was for a child his age.

    I am sure your doctor could help you figure out why the insulin pump would be more beneficial to your child and her current needs.

    HTH :)
     
  14. Mish

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    Does she wake for all her lows at night? If not, she has "hypoglycemia unawareness"

    code words for "pump approved, no questions asked."
     
  15. wearingtaci

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    She doesn't wake up for any bs changes at night,high as a kite or dropping like a stone. She is also maybe 50/50 on feeling hypos during the day. She accidentally went to gym class the other day at 49(she felt fine):eek:
    Out of genuine curiosity,what does hypo unawareness have to do with a pump? I know how it would be important info for getting a cgm
     
  16. sincity2003

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    We have Anthem as well. DS' latest A1C was not below 7, it was actually 9.1, but Anthem approved his pump in 48 hours. I know along with the clinical notes our endo sent a letter of medical necessity; maybe that will help in your case? Good luck and don't give up!
     
  17. hawkeyegirl

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    There have been studies showing that people on pumps have fewer instance of nighttime hypoglycemia.
     
  18. wearingtaci

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    Thanks for clearing that up
     
  19. Mish

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    Yep, sorry. It can point to a wild fluctuation of blood sugars which can more effectively be controlled with a pump.

    It's also a good basis for getting a CGM.
     
  20. wearingtaci

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    she definitely has the wild be fluctuations,and a crazy dip at night that unless we back so far off the lantus that she runs high during the day we can't seem to get right
     

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