The following documents may be helpful in working with your insurance company:
- Letter of Medical Necessity:
- To support your request for reimbursement, ask your doctor for a letter of medical necessity. This letter should serve as a rationale to support why you are a candidate for Continuous Glucose Monitoring and should include the following information:
- Purpose of letter (to request coverage for Continuous Glucose Monitoring device).
- Specific information from your plan on what is considered to be “medically necessary”.
- Description of the device.
- Medical History to demonstrate clinical necessity. For example, detail how often you have experienced hypoglycemia (unawareness or nocturnal). Provide specifics as to incidents requiring medical intervention. Explain how current treatment of self monitoring blood glucose (SMBG) is not working.
- Request approval for device and ongoing supplies and inquire about appeal process.
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TOP TEN
WAYS TO DEAL WITH MONEY AND INSURANCE ISSUES WHILE PUMPING
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1.
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Educate thyself: These issues will be less scary if you know exactly where you stand with your health coverage.
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2.
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Pick a pump company and let the insurance department handle negotiating for you.
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3.
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Make sure your doctor is on board and is willing to write a letter of medical necessity for you. Also, keep good blood glucose logs to prove to the insurance company that you need a pump.
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4.
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If you are on Medicaid or Medicare, you can pursue full coverage of your insulin pump.
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5.
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If you want extra peace of mind, you can take out an insurance policy on your pump.
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6.
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Be patient: Even once you've made your decision to choose pump therapy, dealing with your insurance company can delay your getting started for a few weeks.
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7.
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If you are already pumping, find out when you are eligible for a replacement pump.
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8.
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If you do not have insurance or adequate coverage, plan to fund-raise for your pump.
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9.
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Again, keep a sense of humor: Laughing at the red tape of insurance companies is healthier than getting stressed out by them!
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10.
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Donate money to your local ADA or JDRF to establish a fund for insulin pumpers in need.
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From the book Insulin Pump therapy Demystified
Copyright © 2003 by Gabrielle Kaplan-Meyer
Appears by permission of publisher, Marlowe & Company, a division of Avalon Publishing Group.
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