Turned down for pump

[HuskerMychal]

Insurance turned me down for my pump. They said it is because my c-peptide is more than twice what it should be. Right now Animas and my endo are writing letters to the insurance to see if we can get this overturned. My BG varies so much and I take alot of u-500 by MDI that my endo really wants me pumping. If insurance says no again I dont know what will be next

[Gordonm]

Keep pushing for it and don't give up. Mine took 2 trys but others have had to keep trying. It is well worth it.

[Subby]

Fancy using a c-peptide reading to "prove" normality, when you already have insulin needs way higher than the general population, as shown by your dosages. The cads! Best of luck to your health professionals getting this overturned.

[Funnygrl]

Fancy using a c-peptide reading to "prove" normality, when you already have insulin needs way higher than the general population, as shown by your dosages. The cads! Best of luck to your health professionals getting this overturned.
They're not trying to prove normality. They're trying to prove lack of absolute insulin dependence.

[HuskerMychal]

One of the reasons my endo wants me to pump is i bounce. I can go from 300 to 70 to back to 300 with just a 15 gram carb intake. he wants me to have a more steady BG line

[gettingby]

Mychal, I hope your endo can get your insurance company to see the error of their decision. With your insulin intake and strength, I see the pump being very beneficial to you.

And if we have to, we will start a DF letter writing campaign. :D

[notme]

Appeal Mychal. Insurance companies will battle to the death for things they don't "feel" are necessary. If your doctor feels it is an important part of your therapy, then you will eventually win. Make sure you jump through all of their hoops and do the appeal process to the letter. You will win.

My sister has breast cancer and also has some other problems related to the chemotherapy and an old torn ligament problem with her shoulder. She has been going to PT for awhile to get it resolved before lymph nodes are removed under her arm. The insurance company is battling her. It is insane. She has better things to do with her time than go to PT appointments, but she needs it right now in order to get strong before her surgery in a few weeks.

I understand that insurance companies are in the business to make money. But when you are sick, you count on them. When you need medical help and supplies to stay healthy they need to come through.

Appeal.... You didn't sign up for diabetes. You did sign up and pay for insurance.

[lorilei]

mychal...i am so frustrated for you...seems crazy that we should need to "prove" ourselves "worthy" (ie dedicated) for a pump when it may be in fact the one way you could truly gain control of your bg...that just ticks me off b/c I know how hard u try...arghhh.

[Marcia K in Fl]

The absolute nerve. If it was their body that was bouncing all over would they feel the same?

It is downright wrong.:mad:

[soso]

awww..sorry to hear that.. Keep trying..I will think good thoughts for you..

[SCC]

WHAT? Those creeps. Did you check with ADA to see if their legal resources can help?

My insurance never asked about c-peptide! I'm so sorry.

For the appeal, I"m sure there are studies that you can quote that show the long-term benefits (and savings to the dimwitted insurance people) of treating your diabetes NOW instead of paying for complications later.

Best wishes!

[Funnygrl]

One of the reasons my endo wants me to pump is i bounce. I can go from 300 to 70 to back to 300 with just a 15 gram carb intake. he wants me to have a more steady BG line
It doesn't look like you're taking basal insulin now (based on your sig). I'm also confused why you need U-500 if you're only taking 45 units. You could easily be on the more predictable, fasted acting analogs.

Maximizing your use of MDI will definitely help your appeal for a pump.

[Lizzie G]

as others have suggested, i think keeping a log is a good idea:

a) log all your readings, this will show how erratic they are and also that you make the effort to test

b) keep a log of all your treatment - numbers of shots, and also things like the number of times you have to treat hypos, im not suggesting to exaggerate but certainly dont leave anything out

good luck x

[poodlebone]

My insurance never asked about c-peptide! I'm so sorry.


Some insurance companies will follow Medicare rules when it comes to things like a pump. Medicare covers them only for Type 1s, or Type 2s who can "pass" the c-peptide test, which is how Medicare decides if you're T1 or not. Very low c-peptide, they assume you're Type 1. I guess they figure that if you have a high enough c-peptide and are still making insulin you don't need any extra.

My CDE ran c-peptide and antibody tests before I started pumping. I don't know the exact numbers of my results because I had never heard of the tests before. I do know that when she told me and I asked what it meant, she said I make absolutely no insulin and have millions of antibodies. By "millions", I have no idea if she was saying that to mean "a lot" or if those things are actually measured in millions! I don't know if my insurance company even required those tests or not or if she ran them to see the results for herself.

[Subby]

It doesn't look like you're taking basal insulin now (based on your sig). I'm also confused why you need U-500 if you're only taking 45 units. You could easily be on the more predictable, fasted acting analogs.

Maximizing your use of MDI will definitely help your appeal for a pump.

45 X 3, according to the sig. That's the equivalent of 675 u100 units. U500 seems very suitable in this case.

Maximing use of MDI may not help if they use c-peptide against the proof of such high insulin needs. I'd say the doc needs to try and break apart the so-called relationship between c-peptide and lack of dependency, which in this case, seems laughable.

[Russell A.]

Hey Mike:

Glad to hear your are considering a pump. Thought you mentioned dreading the thought about having an infusion set in your skin, glad you are over your fear. It really is no big deal and most of the time I cannot even tell you were mine is.

Good luck, I am sure you will be approved with a little Persuasion.

Russell

[dianelovesme]

i wasnt turned down, i am getting one soon :].
im 15 and have type 1. and i want to die because its soo stupid somtimes. :]:)

[Funnygrl]

45 X 3, according to the sig. That's the equivalent of 675 u100 units. U500 seems very suitable in this case.

Maximing use of MDI may not help if they use c-peptide against the proof of such high insulin needs. I'd say the doc needs to try and break apart the so-called relationship between c-peptide and lack of dependency, which in this case, seems laughable.
45unit 3x/day is how I read the signature. Units are a standardized measurement regardless of what the concentration is. so either the signature is incorrect, and they are taking 225 units each dose, or the signature is accurate and they're taking 45 units each dose.

[HuskerMychal]

The sig is kinda correct. It is now up to 53 units, 3 times a day with more added if needed and is quite a bit of the time. We have tried adding in simulin and it was no help. I started on 70/30 and I could kill a vial a day is the reason for going to u-500. And both are correct, a unit is a unit. But is kinda like a ounce is a ounce. A ounce of water and a ounce of tequila are both a ounce but one has a diff effect than the other. Trust me if you take a 50 units of 100 you DO NOT want to take 50 units of 500. It would be like taking 250 units of 750, and i do this 3 or more times a day. I have seen this happen when my wife was on u100, she got the vials mixed, was a rough day.

I do have extreme issues tring to walk the card to insulin tight rope but have gotten lots better at it and keeping a avg of about 165 BG that is for 7,14 and 30 day.

Russel, a pump stuck in is still gonna freak me, even the time they had to pin my wrist did that. But just like that time, I know I need the pump and I will cope with it.
:cool:

[poodlebone]

The sig is kinda correct. It is now up to 53 units, 3 times a day with more added if needed and is quite a bit of the time. We have tried adding in simulin and it was no help.

Have you tried Byetta? As I understand it, Symlin works for Type 1s and Byetta is prescribed for Type 2s.

Back to your original post... You mentioned Animas and I was wondering why you went to them to try to get a pump. Many people with large insulin requirements end up going to Minimed (Cozmo used to be a choice, but no longer) because they offer a 300 unit reservoir while Animas is only 200. The Accu-Check Spirit has the largest reservoir, 315 units.

[Funnygrl]

Now I'm really confused. Are you drawing the U-500 insulin to the 53 mark on a U-100 syringe? If so, you're taking 265 units, not 53. Or are you drawing the U-500 up to 10.5 unit mark on a U-100 syringe? Then you're taking aprx 53 units.

And the point stands that you still clearly need basal of some form. I doubt any insurance company would approve a pump for someone on no basal insulin.

[notme]

Whatever the reason, I still find it absurd that a doctor believes the best course of treatment might be a pump and an insurance company can over ride what a doctor thinks. Since when did they get to be my doctor?

I feel insurance companies have the right to call a doctor and ask for clarification, but to deny a piece of medical equipment because there is a cheaper way defies logic.

[HuskerMychal]

Now I'm really confused. Are you drawing the U-500 insulin to the 53 mark on a U-100 syringe? If so, you're taking 265 units, not 53. Or are you drawing the U-500 up to 10.5 unit mark on a U-100 syringe? Then you're taking aprx 53 units.

And the point stands that you still clearly need basal of some form. I doubt any insurance company would approve a pump for someone on no basal insulin.

I draw u-500 up to the 53 mark on a 1cc syringe and we have tried basal. but with my resistance so high it did not help.

poodlebone - I went with the ping because i know person that use it and it is the one i like, alkso because I have used the dexcom 7 system and will be going back to it. the nexgen of it is supposed to talk to the ping.

[poodlebone]

And the point stands that you still clearly need basal of some form. I doubt any insurance company would approve a pump for someone on no basal insulin.

U-500 is regular insulin and lasts a lot longer than Humalog/Novolog/Apidra. I can see not needing a basal insulin during the day because of the U-500 tail, but what about overnight? Mychal, how are your fasting numbers?

[HuskerMychal]

Fasting numbers are in the 90's and I do not get dawn phenom.

[Subby]

Definitely get the pump you want. But the point about the reservoir is not a small one. It's going to dictate how often you change the reservoir. While I'd hardly call the process taxing, it does take a few minutes, and is a bit of a fiddly process. I get sick of doing it every 3 days myself. But it's true I dislike fiddle.

To compare, based on taking about 160units (as if u100 units, the way you are approaching it right now) this is how long each refill will last:

Ping with 2ml res - about 30 hours
Minimed with 3ml res - about 46 hours

[fatfreddiescat]

thats quite an Rx regimen there. The insurance loves you! Right out of their end of year performance fund! I hope you have good doctors! AND, push comes to shove, there are attorneys that will CRUSH those hacks at the insurance caves! Good Luck, and be mean. The adjusters/claims folk are going to be mean, so must you!

[Funnygrl]

U-500 is regular insulin and lasts a lot longer than Humalog/Novolog/Apidra. I can see not needing a basal insulin during the day because of the U-500 tail, but what about overnight? Mychal, how are your fasting numbers?
R still isn't basal insulin, though, and insurance companies may look at that and deny it based soley on that.

If you're drawing up U-500 to the 53 unit mark on a U-100 syringe, you're taking 265 units, not 53.

[HuskerMychal]

No, I am still taking 53 units. 53 units of U-500 which would be equal to the amount of 265 units of u-100 if I was injecting u-100. If I was to inject 265 units times 3 everyday of 500 I would need to have a stock of glucogen pens around.

And as stated in this and other threads, We have tried other insulins and boluses. I just have not mentioned all we have tried. U-500 was the only thing that has worked.

[Funnygrl]

No, I am still taking 53 units. 53 units of U-500 which would be equal to the amount of 265 units of u-100 if I was injecting u-100. If I was to inject 265 units times 3 everyday of 500 I would need to have a stock of glucogen pens around.

And as stated in this and other threads, We have tried other insulins and boluses. I just have not mentioned all we have tried. U-500 was the only thing that has worked.
A unit refers to the actual action of the insulin. U-500 means there's 500 units in one ml. U-100 means there's 100 units in one ml. The marker on the syringe refers to volume. The units are only accurate if using U-100 insulin. U-500 has 5x as many units in one ml, therefore, to get your "units" of insulin if you're using a U-100 syringe, you need to multiply by 5.

So in short, you're injecting 0.53 ml of insulin, which is 53 units if you're using U-100 insulin, or 265 units if you're using U-500 insulin. A unit is a unit whether it's U-40 or U-100 or U-500.

[SCC]

Just received an email with link about this thread!~
BD Diabetes - Learning Center (http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=14206)

[DCaplinger]

45unit 3x/day is how I read the signature. Units are a standardized measurement regardless of what the concentration is. so either the signature is incorrect, and they are taking 225 units each dose, or the signature is accurate and they're taking 45 units each dose.

Time out. I think it's important to understand what we are talking about before we start guessing.

1 unit is 1 unit. It doesn't matter if it's 1 unit of u100 or 1 unit of u500. A single unit is still a unit, the difference is how much liquid it takes to get that one unit. Now, if you draw up 5 units of u100 on a 1/2 cc (1/2 ml) u100 syringe it would be totally different than drawing up the same amount of liquid into the same needle from a u500 bottle. If I hear someone say they are taking 50 units, I assume it is 50 units. If they meant 150 or more, they should have said 150 or more.

Hope that clears this up.

EDIT: Funnygrl said the exact same thing in her quoted post, I just expanded on it.

</ END OF RANT :) >

As to the original point of the thread... good luck. I still don't understand how an insurance company can say you don't need something your doctor has prescribed. I certainly wouldn't sit idly by and let them pass me up that quickly.

Regards,

D

[zatff]

Some insurance companies will follow Medicare rules when it comes to things like a pump. Medicare covers them only for Type 1s, or Type 2s who can "pass" the c-peptide test, which is how Medicare decides if you're T1 or not. Very low c-peptide, they assume you're Type 1. I guess they figure that if you have a high enough c-peptide and are still making insulin you don't need any extra.

My CDE ran c-peptide and antibody tests before I started pumping. I don't know the exact numbers of my results because I had never heard of the tests before. I do know that when she told me and I asked what it meant, she said I make absolutely no insulin and have millions of antibodies. By "millions", I have no idea if she was saying that to mean "a lot" or if those things are actually measured in millions! I don't know if my insurance company even required those tests or not or if she ran them to see the results for herself.

Unfortunately these arbitrary rules have nothing to do with your medical needs or treatment needs. My endo said he would never waste time and money giving such a test since it has no relevance to my medical needs. Fortunately my group insurance has to cover anything that is deemed "medically necessary" but not all states have such rules It is unfortunate that Medicare and lots of other programs will waste millions on lots of unnecessary treatment but deny funding for treatment that is very cost effective and beneficial for patients.

It doesn't hurt to appeal it as far as you can. Sometimes it pays off.

[HuskerMychal]

Just heard from Animas. My pump appeal was approved and I will have my new ping on Friday YEEAAA. Now to learn all about it and u-500 being pumped

[enigmalady777]

That's wonderful news!!!! Good for you!!!!

[jillrapp]

Just heard from Animas. My pump appeal was approved and I will have my new ping on Friday YEEAAA. Now to learn all about it and u-500 being pumped


Congratulations!!!!! I am soooo excited for you!!

[DCaplinger]

Excellent! We'll be fellow newbs. :)

Just FYI, pumping u500 in the US would be an off label use, however I do know that it can be configured to do so. I've already inquired about doing so with my doctor because of my total daily need being so high.

Good luck!

Regards,

D

[HuskerMychal]

I know there are afew here on DF that pump 500. My endo has never had a patient that does before tho. So this will be new for both of us

[palefacegirl03]

Just heard from Animas. My pump appeal was approved and I will have my new ping on Friday YEEAAA. Now to learn all about it and u-500 being pumped


Congratulations. Looking forward to see how you like it.

[poodlebone]

Congratulations on getting your pump approved!

[Subby]

Good one, glad to hear it! I unofficially rename this thread, "turned up for pump"!

[alicat61]

:) Hi Mychal,
I'm really pleased for you, good luck with it all.

[HuskerMychal]

As of today I am now pumping for real (saline) but soon it will be insulin too :)

My nice hot pink pump and green sets, :D sure made the CDE laff and wonder about me
:confused:

[poodlebone]

Mychal,

They didn't really send you a pink pump, did they?!

[Granny Shanny]

Were they going for Husker red & missed?! http://i20.photobucket.com/albums/b202/sneezytwo/grin1qb.gif http://i20.photobucket.com/albums/b202/sneezytwo/grin1qb.gif http://i20.photobucket.com/albums/b202/sneezytwo/grin1qb.gif

[HuskerMychal]

Mychal,

They didn't really send you a pink pump, did they?!

You bet they did :D pink and lime green sets too. If you knew me you would know how well it fits me. Been known to dye my hair any color on a whim too. Right now it is green

Were they going for Husker red & missed?! http://i20.photobucket.com/albums/b202/sneezytwo/grin1qb.gif http://i20.photobucket.com/albums/b202/sneezytwo/grin1qb.gif http://i20.photobucket.com/albums/b202/sneezytwo/grin1qb.gif


No since I bleed BIG RED that was enough

[SCC]

No kidding - I guess i was on vacation when the approval came throught, so I saw the update to this and caught up on the thread. So congrats and WAY TO GO. You deserved it and won! Sometimes the process does work. Sorry it was so painful, but victory in the end, anyhow.

[poodlebone]

You bet they did :D pink and lime green sets too. If you knew me you would know how well it fits me. Been known to dye my hair any color on a whim too. Right now it is green

That's fantastic! You're a brave man. I bet there are very, very few who would accept a pink pump.

[HuskerMychal]

Not really brave, just wierd and I really do not give a flying F%ck what anyone thinks about me. :cool:. Also at my size I am pretty dam sure no one will mess with me and I am pretty secure in me.:D

[Cormac_Doyle]

It doesn't look like you're taking basal insulin now (based on your sig). I'm also confused why you need U-500 if you're only taking 45 units. You could easily be on the more predictable, fasted acting analogs.

Maximizing your use of MDI will definitely help your appeal for a pump.

He's not taking 45 units, he's taking 225 ... he divides everything by 5 ... it's really confusing

I've called him on that one before, because I'm on U500 also ...

What he's doing is using a u100 calibrated syringe (so 40 "units" actually represents 200 units of insulin) ... and he calls that 40 u500 units ...

This is precisely the sort of lazy short-hand that made the ADA (and equivalent organizations in many countries) advise that u500 should not be made generally available ...

[HuskerMychal]

He's not taking 45 units, he's taking 225 ... he divides everything by 5 ... it's really confusing

I've called him on that one before, because I'm on U500 also ...

What he's doing is using a u100 calibrated syringe (so 40 "units" actually represents 200 units of insulin) ... and he calls that 40 u500 units ...

This is precisely the sort of lazy short-hand that made the ADA (and equivalent organizations in many countries) advise that u500 should not be made generally available ...

What I am doing is using the amounts as told to me by my Endo. I did not arbitraly decide to take a certian amount and they do not make U-500 syringes. Need to have some amount to take, cant just say "oh that looks like a enough". Best thing I can say is I take the amount I need. That is all that needs to be said about it.

[Cormac_Doyle]

A unit refers to the actual action of the insulin. U-500 means there's 500 units in one ml. U-100 means there's 100 units in one ml. The marker on the syringe refers to volume. The units are only accurate if using U-100 insulin. U-500 has 5x as many units in one ml, therefore, to get your "units" of insulin if you're using a U-100 syringe, you need to multiply by 5.

So in short, you're injecting 0.53 ml of insulin, which is 53 units if you're using U-100 insulin, or 265 units if you're using U-500 insulin. A unit is a unit whether it's U-40 or U-100 or U-500.

Quote for truth

I really don't understand why this is so hard to understand.

Think of it like alcohol

There is 1 unit of alcohol in half a pint of beer, or a single shot of whiskey ... so if you dink half a pint of whiskey, thats somewhere close to 20 units ...

Same - there is one hundred units of insulin in 1 ml of u100
there is five hundred units od insulin in 1 ml of u500

Say it with me.

"A Unit is a Unit"

[It Ain't Over]

Quote for truth

I really don't understand why this is so hard to understand.

Think of it like alcohol

There is 1 unit of alcohol in half a pint of beer, or a single shot of whiskey ... so if you dink half a pint of whiskey, thats somewhere close to 20 units ...

Same - there is one hundred units of insulin in 1 ml of u100
there is five hundred units od insulin in 1 ml of u500

Say it with me.

"A Unit is a Unit"
Funny how these discussions often get to the alcohol analysis.:D

[poodlebone]

I have no problems translating Mychal's dose of "40 U-500 units" into 200 units of U-100 in my mind. It's not even something I have to think about. If he wants to explain his dose in volume rather than units I don't think it's a huge deal. If people can't figure out how much he's actually taking then maybe a 4th grade math refresher course is needed.

[HuskerMychal]

Quote for truth

I really don't understand why this is so hard to understand.

Think of it like alcohol

There is 1 unit of alcohol in half a pint of beer, or a single shot of whiskey ... so if you dink half a pint of whiskey, thats somewhere close to 20 units ...

Same - there is one hundred units of insulin in 1 ml of u100
there is five hundred units od insulin in 1 ml of u500

Say it with me.

"A Unit is a Unit"

Cormac_Doyle, I have no issues understanding. Just going off what the medically trained person told me. The issue in understanding would be from the people that continue on about it when I had just said to drop it. It is starting to irritate and just to appease the person(s) that wont drop it I will just edit my signature to not show my dosage. Which has changed anyway and now that I will be pumping will change again.


And thanks Poodlebone, my thoughts too. If you can do simple math it was easy. But please all, this is now a moot point

[Subby]

Congrats on getting hooked up Mychal. I didn't do saline and I wonder how I would have gone with that, the reason I don't mind the pump attached at all, is because it's doing such great things all the time. If it was just saline and pretend it might irritate me but I don't know. It stil sounds like a reasonable idea. How are you finding it?

[HuskerMychal]

It is Ok, it helps me adjust to having this tube hooked to me and things I have to learn to look out for. For instance, I keep it in my pcket and first time I took my pants down to go to the restroom I about ripped it out of my belly. I also have learned I am gonna have to shave my belly LOL

[housefinch]

That is frustrating.

I was turned down 3 or 4 times for a pump. My insurance at the time was Health Net, Alta Bates Medical Group. Reason: My A1c was TOO LOW. (It ranged from 6.4-6.9 at the time).

This makes about as much sense as you getting turned down for a high C peptide.

After many, many phone calls, letters and months, I finally discovered that if I switched my medical group (which required switching my primary medical doctor), that they would approve me for a pump, but only a Cozmo.

Kaiser said they would approve a pump if my doctor ordered it--clear and simple, the way it should be.

You might try doing some investigating within your medical group (if you have an HMO), as they actually have more power than your overall insurance. And, they might have inexplicable idiosyncracies. (sp?).

Good luck, and keep trying!