Us Vs. Insurance Company PUMP SMACKDOWN!!!!
A little background... We've been trying for SO long to get our son approved for the insulin pump. We've been working on this since April.
Each time, insurance asks for more and more info, be it lengthier and more detailed bg/insulin/activity logs (for two weeks we wrote down every food he ate and exact carb counts... not just "granola bar, 30 carbs, breakfast" but "Nature Valley Oats N Honey granola bar, 28 carbs, 8:20 am"... not "15 minutes exercise" but "15 minutes swimming backstroke at moderate rate" etc etc.. THEN! They told the distributor that they wanted this same material, not for two weeks, but for TWO FUCKING MONTHS... I had to fax 27 pages of data to them!! 27!), typewritten doctor's notes (because they couldn't "read" the doctor's writing... so the nurse practicioner typed it up for us)...
In short, they are evil and do not want to pay for the pump. It is a $5000 item, but still. My son has Type 1 Diabetes. Insulin pumps are quickly becoming standard therapy for this chronic, incurable disease, and have been shown to improve long term blood glucose control and diminish complications. DUH!
Well, today, we WERE supposed to get our final reply. The pump distributor called us (she's been really helpful) and told us that insurance said...
"We aren't convinced this item is medically necessary for the patient. The patient's highest a1c (a1c refers to the amount of glucose floating around in the blood over the past 3 months... the lower, the better) was 6.2, and we look for a 7.0 or above."
WHAT? So, we are doing too good a job with shots to qualify for the pump?
We are being punished for taking too good care of our son!!!!!
Let's just slack off and be asses for awhile shall we? Maybe we can bump his a1c up to 10 or even, whatthehell, 12 if we just stop fucking testing and carb counting!!!! Woo hooo let's see just how badly we can damage his organs! What the hell it's for a good cause!
I'm sorry but this is the definition of FUCKED. UP.
They haven't exactly said "No" yet... but they are referring it to THEIR onstaff doctor, and then he is supposed to look over the records etc. If they disapprove the pump, we can still appeal. Our doctors can call their doctors and explain our son is still "honeymooning" (his pancreas is still making small amounts of insulin and his numbers are easier to control, which they won't always be), etc.
We should know more on Monday...
This is so fucking stupid. SO FUCKING STUPID. So, you would rather pay for heart bypass surgery years down the road at a cost of $60,000, than pay $5000 for an insulin pump now. You would rather pay $50,000 for a nontraumatic limb amputation, than $5000 for a pump. You would rather pay $45,000 per year for kidney dialysis, than $5000 for a pump that could prevent these complications. You fucking jerks, just go to hell.
'Kay so I realize these complications are not inevitable with shots. Many people do quite well with shots. My neighbor's one, and there are many others. We'd survive just fine on shots if we had to. 'Kay, 'kay, 'kay but you know what? When his pancreas resigns from his body for good, stuff won't be so easy. AND, there are social issues to consider. Eating spontaneously, like his classmates do. Integrating FOOD into LIFE in a way that SOMEWHAT approximates the way *I* integrate food into life. Hey, are you hungry? So grab an apple. See, it's not so easy for people with diabetes. They have to inject insulin for that apple that you and I just take for granted. With a pump, all my son would have to do is press a button for 15 grams of carbs. No sterilizing the insulin pen, "air shots", sterilizing injection sites or pinching up fat for an injection. I mean seriously imagine if every time you had something to eat, you had to do that. Isn't a device that makes that very human act of EATING, worth it, just psychologically?
Besides which, I still think that with a device that has been successful for so many people there shouldn't even be a question... WELL, a doctor should just be able to write a prescription and you get the fucking thing. I could walk into a huge variety of doctors in this state, and get a prescription for POT within fifteen minutes, because I am so stressed over all this diabetes crap. My son sees the finest diabetes doctors in the land at University of California-San Francisco. Insurance can't just take their word for it that he needs A FUCKING INSULIN PUMP and would benefit???
Whoops, my naughty language is showing. Someone said to me the other day that I seem angry a lot on my blog. Ya think?
Well, SURREE, but Fuck It.
Regarding this situation, one friend of mine very wisely suggested that we consult an attorney. We plan to, should we hear bad news on Monday.
Another friend mentioned that her friend had had trouble getting the pump approved for her son. She contacted the media. And her son's pump start was broadcast live on New Jersey TV!
This has all given me food for thought. I am going to contact Michael Finney at Seven on Your Side to start with, along with an attorney, should we receive bad news on Monday. Michael Finney kicks big corporate butt and I think he would be VERY interested in this situation.
And, we may consult a psychologist I know who specializes in children with chronic illnesses. I'll bet she could come up with BINDERSFULL of information about how it benefits a child with a chronic disease to make their lives more like "everyone else's."
Wish us luck. I hate the waiting.