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Does Insurance Cover Insulin Pumps

Health Insurance And Diabetes

Health Insurance And Diabetes

Almost everyone with diabetes has a run in with health insurance concerns at one time or another. A quick search of "diabetes" and "insurance" brings up hundreds of forum topics with people talking about their insurance woes. Most people with diabetes either have insurance that won't cover enough of their diabetes needs, like test strips, labs, and doctor's visits or don't have insurance to help at all. If you have insurance, how do you get them to give you the coverage you want and need? If you don't have insurance what other options do you have? There are a couple of things you can do to help insurance maneuvering go smoother and we’ve listed some of them below. We’ve also included some helpful links for further reading. Know your Insurance Your physician and diabetes healthcare team will help determine what you need for good control. Be sure to obtain any referrals that may be needed to see specialists, such as an endocrinologists or internist or diabetes educator who specializes in glucose control and handling of diabetes complications. From their suggestions, you want to check with your insurance company to see what they cover, which brands they cover, and what amounts they cover. Find out if you have to visit certain pharmacies for your supplies. Your copay may be lower if you order your medications and supplies by mail. You should ask about test strips, insulin, medications, lancets, syringes, insulin pumps, continuous glucose monitors and any other supplies your team suggests. Also, ask if they reimburse for cash purchases from companies that don't accept insurance payment. Most insurance companies cover insulin pumps and supplies. The pump companies will help you through the insurance process if you contact them. Visit our Current Insulin Pumps page for lin Continue reading >>

Insulin Pumps, Diabetes And Health Insurance

Insulin Pumps, Diabetes And Health Insurance

Are insulin pumps covered by private health insurance? Compare the benefits offered to people living with diabetes from Australian health funds. If you suffer from diabetes, your doctor or other medical specialist may recommend that you use an insulin pump. Worn 24 hours a day, an insulin pump delivers a constant supply of insulin and helps blood glucose levels remain stable. Happily, if you have an appropriate level of hospital or extras cover in place, the cost of your insulin pump may be covered by your private health fund. Consult your health fund to find out what level of cover is available to you. In many situations you will not need to be hospitalised in order to receive an insulin pump, so you’ll need to check whether your fund covers the cost of an insulin pump where hospitalisation is not required. This guide will explore the conditions of when insulin pumps will and will not be covered. Compare health funds and enquire for cover for insulin pumps About You Tell us about yourself for your quote. How will my private health fund cover me if I need an insulin pump? The Private Health Insurance Act 2007 stipulates that private health funds can cover the cost of insulin pumps under either their hospital cover or general treatment cover policies. However, the level of cover provided varies depending on whether you receive the pump is provided as part of hospital treatment or not. For example, if you are hospitalised due to diabetes and receive an insulin pump, and if you have an adequate level of hospital cover in place, your health fund is required to provide cover for: The cost of the insulin pump Your hospital accommodation fees Your doctor’s fees However, in many situations you will not need to be hospitalised in order to receive an insulin pump, so you’ll Continue reading >>

Everything You Need To Know About Insulin Pumps

Everything You Need To Know About Insulin Pumps

Everyone needs insulin to live. Insulin is a hormone that helps our bodies use and store the food we eat. People with Type 1 Diabetes no longer make insulin and have to give insulin in order to sustain life. People with Type 2 Diabetes don’t use their own insulin well, and over time can have trouble making enough. So, all people with Type 1 diabetes and some people with Type 2 diabetes need insulin. When people give insulin injections, they may take 1-2 injections of a long acting insulin every day and 3+ injections of rapid acting insulin for meals and snacks. The typical person with Type 1 Diabetes could take anywhere from 4-7+ injections a day. Many people currently give insulin through an insulin pen or a syringe. But, there is another option, an insulin pump. An insulin pump delivers rapid acting insulin in two ways. First, the pump is programmed to give you insulin every hour throughout the hour referred to basal insulin. Basal, think “base,” is the insulin your body needs even in the absence of food, it is also referred to as background insulin. This basal rate replaces the long acting injection that you take. Second, is bolus, this is the insulin you take for food or to correct a high blood sugar. If you get basal and bolus confused, think “bowl”, as in you eat out of a bowl, to help you remember bolus is for food. Once you are on a pump, all insulin is delivered through the pump and shots are no longer necessary. Components There are a few things necessary to make a pump work. When a pump is shipped to someone: they will also need to send infusion sets, reservoirs, and possibly batteries, depending on your pump. Let’s talk about each component. Infusion Sets An infusion set is the part that is actually inserted into the body and has tubing that conn Continue reading >>

Insulin Pump Insurance

Insulin Pump Insurance

Tweet If you qualify and get hold of an insulin pump on the NHS, you will be expected to insure it. Insulin pumps are expensive items and whilst you may be able to insure your pump under your home insurance policy, it’s best not to make any assumptions. For those whose insulin pump is not covered under an existing insurance policy there is a UK company that specifically offers insulin pump insurance. Is it worth insuring my insulin pump? Insulin pumps typically cost between £2,000 and £3,000 so it would be very risky to choose not to insure your pump. What can wrong with my pump? If a pump develops a fault and the pump is within its warranty then the manufacturer should cover the cost of repair or replacement. However, a number of other problems can occur such as: Accidental damage - e.g. being dropped or trodden on Being lost - e.g. in transit on holiday or when removed to play sport Being stolen - this has been known to happen Is there a specialist insurance policy for insulin pumps? A UK company called Insurance4InsulinPumps comes recommended and offers to settle claims quickly. Is my insulin pump covered by my home and travel insurance? It is possible that home and travel insurance may cover your pump but as it is such an expensive item, not all insurers will cover it. If your home insurance covers your pump, you will need to check which eventualities are covered, such as whether incidences at work or otherwise away from home are included. How much should an insulin pump be insured for? The NHS generally recommends that insulin pumps are insured for £3,000. Which type of insurance policy should be chosen? Ideally, look for comprehensive cover to ensure theft, loss and accidental damage are included. When insuring my pump, what will I need to consider? It’s wo Continue reading >>

Is My Test, Item, Or Service Covered?

Is My Test, Item, Or Service Covered?

How often is it covered? Medicare Part B (Medical Insurance) doesn’t cover insulin (unless use of an insulin pump is medically necessary), insulin pens, syringes, needles, alcohol swabs, or gauze. Medicare prescription drug coverage (Part D) may cover insulin and certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs. If you use an external insulin pump, insulin and the pump may be covered as durable medical equipment (DME). However, suppliers of insulin pumps may not necessarily provide insulin. For more information, see durable medical equipment. Your costs in Original Medicare You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the Medicare-approved amount, and the Part B deductible applies). You pay 100% for syringes and needles, unless you have Part D. To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like: Other insurance you may have How much your doctor charges Whether your doctor accepts assignment The type of facility The location where you get your test, item, or service Continue reading >>

Does Health Insurance Cover An Insulin Pump?

Does Health Insurance Cover An Insulin Pump?

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications. Continue reading >>

Insulin Pump Therapy

Insulin Pump Therapy

Insulin pump therapy can give you the better control you want for your lifestyle.1, 2 Technology for Joy & Jake What Is Insulin Pump Therapy? An insulin pump is a small device about the size of a small cell phone that is worn externally and can be discreetly clipped to your belt, slipped into a pocket, or hidden under your clothes. It delivers precise doses of rapid-acting insulin to closely match your body’s needs: Basal Rate: Small amounts of insulin delivered continuously (24/7) for normal functions of the body (not including food). The programmed rate is determined by your healthcare professional. Bolus Dose: Additional insulin you can deliver “on demand” to match the food you are going to eat or to correct a high blood sugar. Insulin pumps have bolus calculators that help you calculate your bolus amount based on settings that are determined by your healthcare professional. Buttons to program your insulin LCD screen to show what you are programming Battery compartment to hold 1 AAA alkaline battery Reservoir compartment that holds insulin A plastic cartridge that holds the insulin that is locked into the insulin pump. It comes with a transfer guard (blue piece at the top that is removed before inserting the reservoir into the pump) that assists with pulling the insulin from a vial into the reservoir. A reservoir can hold up to 300 units of insulin and is changed every two to three days. An infusion set includes a thin tube that goes from the reservoir to the infusion site on your body. The cannula is inserted with a small needle that is removed after it is in place. It goes into sites (areas) on your body similar to where you give insulin injections. The infusion set is changed every two to three days. An infusion set is placed into the insertion device and wi Continue reading >>

Fighting For My Life

Fighting For My Life

Time for an update on my campaign to become an insulin pumper. Ouch. Painful experience dealing with Blue Shield, so far. Enormous amount of time spent explaining to perfect strangers -- from the HR reps at my husband's company to various "reimbursement managers" to a parade of officials at Blue Shield (forthwith to be referred to as 'BS') itself -- why I ought to get medical coverage for a life-sustaining device that my doctors have been recommending for nearly four years. Very humbling. "You see, since the day I was diagnosed, my doctors have been telling me that I'd be the perfect candidate for the pump. I'd get improved control of my diabetes, and therefore achieve better health outcomes in the long run. But it was ME who resisted. I didn't want some contraption hanging off my body. But now there's a new, wireless system that will help me control my diabetes without the tubing..." My God, it's not as if this were a cosmetic request! Do you think I'd wear a Pod full of liquid attached to my Bod if I didn't absolutely have to? It's not like I'm asking for a nose job here. Some time back in November I got my first rejection, supposedly on the basis that "continuous glucose monitoring is still experimental therapy." WtF? Do they not even know the difference between a glucose monitor and an insulin pump over there? Then I figured it was a simple mixup with the request for reimbursement that Dexcom (makers of the wireless CGM system I'm now using only occasionally) had placed on my behalf months ago; I had long since given up on seeing any of that money again. Got my endo to contact the Medical Reviewer over at BS to clear that up, but my doctor was told that wasn't the real reason for rejection at all: it was a cost-effectiveness issue, after all. Hmm, pump to prevent ou Continue reading >>

How To Get Approved For Pump Therapy

How To Get Approved For Pump Therapy

A certified diabetes educator provides a step-by-step process for getting fitted with an insulin pump. Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community. Q – I want to use an insulin pump, but I hear insurance might be a problem. Can you tell me how one gets approved for a pump by a doctor and insurance? A – It’s smart to at least consider an insulin pump as a treatment option. The precision in how insulin is delivered with a pump can make a notable difference in blood sugar control. Your first step in procuring an insulin pump is to talk with the doctor who helps you manage your diabetes. Many endocrinologists and certified diabetes educators have demo insulin pumps in their offices or information from different pump companies that they can give you. It’s important to discuss with your doctor what you hope the pump will do for you and the reasons you feel it will be an asset to your blood sugar management. For many people, pump therapy may be easier than multiple daily injections, but it is only effective if the person using it understands the pump and is proactive about blood sugar control. Doctors don’t automatically approve pumps for all their patients with diabetes, and some will refuse to prescribe pump therapy until blood sugar levels are improved to a certain level with traditional insulin therapy. It’s important to advocate for why you believe a pump could help improve your blood sugar management. Bring blood sugar logs and records to your visits, and give concrete reasons why multiple daily injections alone isn’t cutting it. When consi Continue reading >>

Diabetes: Should I Get An Insulin Pump?

Diabetes: Should I Get An Insulin Pump?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Get the facts Key points to remember An insulin pump can free you from a strict regimen of meals, sleep, and exercise, because you can program it to match your changing schedule. After you learn how to work with a pump, it can make living with diabetes easier. But it takes some time and effort to learn how to use the pump to keep it working properly and to control your diabetes. Using a pump includes checking your blood sugar many times a day and carefully counting the grams of carbohydrate that you eat. Using an insulin pump can keep your blood sugar at a more constant level so that you don't have as many big swings in your levels. People who use pumps have fewer problems with very low blood sugar. Many insurance companies cover the cost of insulin pumps, but they have strict guidelines that you will have to follow before they will pay. Continue reading >>

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