[Lloyd]

I am wondering how low my A1c can be and still get my insurance company to authorize a pump?

If some people were willing to say what their A1c's were when authorized, it might give me some idea what I am up against.

Five months of tweaking my oral meds gave really bad results for me. Two months of Lantus turned out even worse, but Novolog is working very well. I don't know that I can swing the cost of a pump right now, I have a high deductable.
My last A1c was 7.8
The previous one was 8.4
Projections of my next one, in March, are for about a 6.0 A1c, based on my glucose average of 127 for the last month.
So.. I am thinking if I don't get a pump before March, I might be stuck on MDI forever. My doctor thinks I would do well on a pump, I do too.

Your thoughts anyone?

[KritterMom]

I'm a type 2 that recently got a pump. My A1C's were in the 7-8 point range. My dr. fought with the insurance company for 9 months to get a pump for me, but they were denying it because I was a type 2, and they said type 2's don't need pumps. My A1C's weren't very good, but I don't think it was about the A1C's with my insurance company. They finally approved me though. If your dr. thinks you are a good candidate, and you are a type 1, I wouldn't think it would be hard to get one.

[Lloyd]

Originally Posted by KritterMom

If your dr. thinks you are a good candidate, and you are a type 1, I wouldn't think it would be hard to get one.

I forgot to say, I'm a type 2. I take 100 units of novolog 70/30

[melissata]

It will depend on the insurance company. The HMO that we just changed to used Medicare and Medicaid guidelines and required a C peptide test. That is their way of being sure not to give pumps to type 2s. My daughter is a type 1 and they made a mistake and told us that her C peptide was too low to qualify her for a pump. It is actually just the opposite and their cutoff was 0.7. You need to be producing very little of your own insulin in order to get that low a score.

[David]

I was in the low 7's before I got my pump. On that basis alone my insurance probably would have rejected a pump, but my endo wrote a letter of necessity based on my records that showed a history of wide swings in my BGLs.

David

[valc3]

My last 2 A1C's were 5.6 and 6.4, the endo sent in the paper work showing the necessity and my insurance company approved it within 24 hrs. Started pumping today.

[Funnygrl]

A good starting point it to get off 70/30 and go on mdi. Proving to your insurance you are willing to inject a lot and count carbohydrates and adjust insulin doses appropriately may prove to them that you are motivated and make them more willing to pay. It's very rare for someone to go from such a simple dosing regimine to a pump directly.

[notme]

Hi Lloyd, it really depends on what your insurance company requires. I am a type one and was on MDI for 14 years before switching to the pump. My A1c was awful, but better than before. When I went in to see my GP my A1c was at the 11 mark. My GP put me on Lantus and humalog and sent me to a nutritionist. I lowered my A1c to 8.5 before going to an endo. The endo had me keep numbers for one month. After that month, my A1c was 8.0 and then I was put on the pump. My first A1c after going on the pump was 6.5. I have remained in the six range since.

Some insurance companies want you to have low A1c's which seem ludicrious to me since you would think they would feel you were doing so well on injections, you wouldn't need a pump. (I don't subscribe to that theory). Some insurance companies want you NOT to be able to control on MDI and only will prescribe if your numbers are awful. Go figure. Most will accept a doctors note of medical necessity. I got that from my endo and have been on the pump since.

Call your insurance and talk to them. It could be they are one of the tough ones that will not prescribe a pump to someone with type two. I hope not.

Good luck to you. I hope you get your pump soon and are on the road to good health.

[Gordonm]

My last two A1cs were 5.8 and 5.9. I have not been above 6.4 in the last 5 years. I just got my pump 3 months ago and could not be happier. I just told my endo I wanted the pump and he wrote out a perscription and the reps and people at MiniMed did the rest. I was approved in 2 days.

[KritterMom]

Wow, I sure wish my experience would have been like that. I guess the fact that I'm a Type 2 made a difference too, but I thought for sure they would just keep denying it. I don't know what my endo said to them, but it must've finally made a difference, 9 months it took to get approved, and about 4 days for the pump to arrive.

[JasonJayhawk]

Lloyd,

Melissa's and notme's advice are right on. It depends on your insurance company, and they don't look just at your A1c level. With Type 2 diabetes, you've got to meet a different set of guidelines than from Type 1, which will likely include the C-peptide blood results.

It completely depends on your insurance company. Some companies, such as Cigna, actually post their policies for the world to see.

You can, of course, get on a pump with no problem if your doctor prescribes it and you pay for it all out of pocket.

Most insurance companies consider several factors, including (but not limited to) glycemic excursions (have you had dangerous lows or highs that resulted in hospital ER visits or admissions?), A1c, frequency of injections (with 70/30 insulin, you're pretty much stuck to 2 injections per day (insignificant compared to the MDI that most pump users have escaped), and current complications (if your kidneys are failing, you have a better chance).

Since you're on 70/30, and the common prescription is for two injections of it a day (for the NPH insulin protamine to cover 24 hours), a pump is unlikely to be covered at all.

FYI, Funnygrl is right -- you'd best get practice with the basal/bolus way of a pump by switching to a different insulin regime if you want to consider a pump in the upcoming years!

Good luck!

[poodlebone]

My A1cs before I got my pump were in the low to mid 5 range. I don't know what my insurance company's requirements are, but if a bad A1c was one of them then I would have been denied. I got those "good" results by having BGs ranging from the 20's to 200's every day. My numbers were all over the place. But, I did test my BG and log my results and my CDE took copies of those. At my very first appointment with her she recommended a pump, sent some paperwork to Minimed, who then contacted me the following week. I faxed them a short form they sent over and my pump was shipped that day. Total time between the CDE suggesting a pump and me having it in my hands was 9 days.

All insurance companies, and even different plans from the same company, are different. I have to say that I am very pleased with my HNMO and it's so much better than the "premium" POP (POS? something like that) plan I had before.

[melissata]

Jason is correct, except that my daughter is a type 1 and already has been on a pump for 4 years and STILL had to have a C peptide done. Made no sense at all, but we still had to do it. Even using Medicare and Medicaid guidelines like they did, there is still an exception if someone is already on a pump prior to changing to that insurance. I found that on line way late in their game though!

[KritterMom]

It's weird with me because, to my knowledge, a CPeptide test was never done on me, even though I personally requested one. The dr.'s just wanted to call me a type 2 because I was dx'd when I was pregnant 20 years ago with my last child. My mom was a type 1, and my doc thought I might have Type 1 tendencies, but no one ever did a cpeptide test. I thought that was strange.

[Funnygrl]

I had a c-peptide test before I got my pump and it was almost normal. A year later I suspect it wouldn't be though. And my insulin requirments have gone up 4x since then.