Our Insurance Fight

Our Insurance "Fight"

     Dun-Dun-Dun, the dreaded insurance coverage guideline. The glaring words shouting out from my computer screen stating that insulin pumps are only possible after a six month waiting period after the patient completes MDI (Multiple Daily Injections) and can submit logs. I see this and think “challenge accepted”. So at 1.5 months after diagnosis, I tell my doctor that I am asking for them to work with me on getting approval for a pump for our daughter. They basically tell me that my insurance has a waiting period of 6 months, and that generally the first request is denied, especially within the first six months but they would be happy to get the process started if that was "my wish" (I can tell they think I've got no shot but if I want to waste my time then so be it).  We review the pump options and settle on the Animas Ping due to the micro-dosing abilities, waterproof technology, and the remote control. I’ve already met the deductible this year because of her hospital stay, so I do not want to wait until the end of the year to apply and then be denied. She needed micro-dosing abilities because of her honeymoon period and was either going too high or too low because you couldn’t get more precise with a syringe. Normally the excuse to delay pumping is because of the honeymoon period but it was the opposite with my child.

     So here is what I did. I contacted the Animas rep and got the application. I submitted said application along with a lovely little letter I call the pre-appeal. Instead of having to appeal a denial a month later, I figured I’d put my appeal points into a lengthy letter that would have done a lawyer proud. At the top of the letter, I placed a smiling photo of my daughter which just dared them to deny her. I then reviewed 8 points of why she needed a pump before the 6 month waiting period ended. Luckily at my last job before becoming a stay-at-home mom, I did medical appeal letters on a regular basis. So I utilized the format and lingo that were successful with those claim appeals. Then I submitted everything to the rep and waited (kind-of).

     A week and a half later, (after one phone call to the call center to inquire as to how much longer it might be because in the meantime my daughter almost died and that this would be a constant threat until she was on the pump), I received a call directly from the shipping division of Animas telling me that my pump would be sent out that day and at my door within 2 days. I started crying and jumping up and down. You would have thought they had told me that there was a brand new Mercedes I had won in a drawing being delivered. Nope, just our beautiful, pink and shiny new insulin pump, no larger than a cell phone.

     Then….I called my daughter’s Endocrinologist office to ask about pump training. They tell me that we can come in next month (say whattt???!). Apparently they never thought that we would be approved and hadn’t started us on the MDI schedule that mimics the pump yet. I sat there and looked at the formulas. I look at the syringe. I look at the formulas. Then I ask her Dr.’s diabetes educator one important question. How is the MDI schedule you want her on any different than the MDI formulas? Because the whole point of the pump is the dosing is more exact. We were stuck in place on the syringes. In a 3/10cc syringe, .5 is the smallest dose, followed by 1. She was either .5 or 1 depending on the time of day. If we go less, she goes too high. If we go more, she goes too low. So basically I’d be doing the exact same injections for a month while my brand new, hard-fought pump sits in its box in our house. No way! Let’s just say they saw my logic and got her in within a couple days. They told me that my daughter was the fastest to ever receive pump training. So by month two, 9 weeks after diagnosis, my daughter was full-time pumping with the Animas at zero cost to us.