Insulin Pump Coverage

(Perk) #1

Okay... so this is a bit of a rant... but sometimes I just get so frustrated.  So receently in British Columbia Canada the government decided to cover insulin pumps for kids under 18 with type 1 diabetes.  This is GREAT!... my only problem is... that im 25 and still a type 1 diabetic who would love to have better control of her blood sugars and live a healthier lifestyle which I could do with an insulin pump.  But simply, I can not afford the 7000 dollar bill that is attached to the device. 

I do not understand why because i am 8 years to old... i am not eligible for a pump.  it drives me crazy ... I was once a child with type 1 diabetes too!!... arg... it is great that we are taking steps to improve type 1 diabetics health but I dont understand why I can not also have that option... I get it ... it costs money... but so will the complications that i may more readily obtain because i dont have as good of control as I could with a pump. 

What really actually started this rant is that I was looking at the requirements to be able to get one of these gov't funded pumps.  the usual stuff came up such as physician recomndation etc. Fine. The gov't is also allowing for replacement pumps every five years for these individuals which again is GREAT... but... there are certain standards that are to be met.  one being that the individuals A1C must be below 9% on two seperate occasions 6 months prior to the request for the replacement.  The other which is what got me started was that the person must not have had more than 1 DKA episode within the last year.  Fine ... they want to make sure we are taking care of ourselves...but from some of the forums on here... it seems like it could be pretty easy to go into DKA if the pump site does not deliver the insulin or the pump runs out of insulin etc.  Maybe Im just a little bitter about not being able to get an insulin pump but i find it very frustrating that the gov't can put conditions on our health.  Most people try to be healthy ... but may not always achieve this why should they be punished because they dont meet the requirements that were arbitrarily put out by an uneducated system.


thanx for reading :)

(sarahslp) #2

Good point about the replacement pump ... you could go into DKA or have high a1c's b/c the pump wasn't working and that's why you need a new one. I can see why you'd be frustrated. I hope something works out so you can get one if that is what you want.

(amyl1027) #3

     I think what the insurance companies are mainly looking at are DKAs that happen on a constant basis.  If there is a DKA just make sure you have charts to explain why you went into DKA.  Also, I know that you said there is an age limit.  Maybe you could get your doctor and others that you deal with to try getting the insurance companies to make an exception.  They're going to change the limits eventually; it's just a matter of when.  There are far too many Type 1 Diabetics to limit the pumps to those who are under 18.  We all grow up eventually.

(joe) #4

hi Candice,

a guy named Randy Pausch said that obstacles are sometimes put in our way, to see just how much we want something.

You could try talkting to pump manufacturers that are prevalent in your area.  Minimed took less than 4000 for my pump, because that was the "negotiated price" with my insurance co.  I know for a fact that they'll all take less than the "sticker price" for a pump if you are paying for it.  Most companies will also let you make payments without interest too.  If you are really interested you could call and try to negotiate a deal.  just a though.  sorry about your situation but I wish you good luck!



(Kay Smith) #5

you can also call the pump companies to see if they will work with you for a "indigent plan" most companies have this plan and actually need to "right off" a certain amount of $$ each year.

As far as DKA, I work as a trainer for a insulin pump company, and it is actually a severe event that requires reporting if a patient goes into DKA while on a pump. This shouldn't happen.

A1C's this very tricky, and depends on the persons age, activity level, and their growth, and what their md wants their blood sugar goals to be.