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Has anyone succesfully gotten a new pump through insurance in less than 4 years?

Discussion in 'Parents of Children with Type 1' started by nanhsot, May 7, 2013.

  1. nanhsot

    nanhsot Approved members

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    We've got complete pump failure here. Dead in the water, literally, buttons don't work and you can see moisture/water drops inside.

    I've been very happy with animas and am a big supporter but truth be told he is using so much insulin that he needs a pump with a larger cartridge. Would love to switch to Tslim but we're on year 3 in November.

    Is it worth it to pursue insurance coverage of a new one based on insulin needs or is that crazy to even try? Anyone had luck getting insurance to cover in less than the 4 year warranty time?

    (edited to add: if you've tried and failed, I'd be interested in hearing your experiences.)
     
    Last edited: May 7, 2013
  2. mmgirls

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    Some insurance companies will cover in 3 years you just have to check your policy.

    If you are on another insurance company, different from the one that covered the pump that you have now, then you can get a new one.

    We have gotten the Ping when it came out even with an in warranty Animas because we had different insurance when the Ping came out.

    I would get the replacement pump for your in warrenty pump and then start looking into if you can get your Dr to get you a pump with the larger capacity.
     
  3. nanhsot

    nanhsot Approved members

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    Yep, that's the plan, new pump here Thursday morning, on lantus until then. I put in an email to our CDE office asking if they've had any luck with covering a new pump before the 4 year warranty so we'll see if they have any tips.

    Insurance all the same.
     
  4. miss_behave

    miss_behave Approved members

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    Could you get your endo to write a letter of medical necessity based on insulin needs?
     
  5. Sarah Maddie's Mom

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    My guess is that they will just tell you to change the cartridge every other day. It's a drag I'm sure...

    Our only success getting a new pump prior to warranty expiration was when we changed insurance carriers.

    Maddie would also love to try the tSlim, she's never really loved her mm like she did her Coz.

    Good luck though! Let us know if it works out.
     
  6. mmgirls

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    would giving Lantus as basal help at all with running out of insulin in the pump? until you find out about getting a larger pump?
     
  7. Megnyc

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    We had no problem getting one approved several years ago (3 or 4 I believe) right after I had actually gotten a new pump. I had an in warranty MM 522 and because of steroids and puberty I was using 90-100 units a day from 20 units a day when the old pump was purchased. I ended up using Metformin instead of getting a new pump because the insulin use was really excessive (over 3 units/kg at times). I was approved for a new MM 722 no questions asked.

    I just checked my current insurance company's website and it says replacement of in-warranty external insulin pumps is considered medically necessary for pediatric individuals requiring a larger reservoir and says to submit a letter of medical necessity with the current pump volume as well as daily insulin use.

    Personally, I would try it. I would make sure the t-slim works with apidra for you guys since I know some people have had issues. Other then that it looks like a great pump!
     
  8. nanhsot

    nanhsot Approved members

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    I had forgotten about that particular wrinkle, the apidra one that is. Hmmm, will have to weigh the pros and cons.
     
  9. RomeoEcho

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    I would second this. I do it for other reasons as well, but now that I have just switched back to Animas after many years on the 722, I am realizing the advantage of the extra room in the reservoir. I can't get seven days out of a reservoir, but the Lantus gets me maybe an extra day. I take about 30-40% of my basal through lantus, which gives me a lot of benefits.
     
  10. Beach bum

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    This is pretty much what we are doing now. We thought hubby was going to have an insurance change last year and knew the warranty was coming up on our Ping, so we went an ordered a new one...then the T-slim came out:( So now we have to wait 2 more years before we can get a new one. My only hope is maybe insurance will change before then and we can get a new one, or at least when we are ready for a new one that it will be integrated with the Dex.
     
  11. mom2Hanna

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    I switched Hanna from animas to Medtronic 4 months early. My dr said medical necessity to get a bigger cartridge and the cgm. Of course she hated it and now she's on an omnipod, but we did get it approved early
     

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