I Won The Fight!


I’ve been fighting with my insurance company for pre-authorization (required) for the purchase of the t:slim insulin pump system.  I was told flat out by a customer service representative that because my Animas Ping is still functioning I was not going to be approved. Even when out of warranty, they don’t approve a new pump purchase unless the current pump is non-functional.  They would NOT listen to my reasons why I was in need of a new pump. (I need a screen I can see in sunlight! I need a bigger reservoir! I need smaller basal increments!)

A lovely insurance verification rep at Tandem (who is amazing and wonderful) fought with me and contacted my insurance company half a dozen times – only to get the same answers I was getting.  She decided we needed to get medical necessity forms filled out by my doctor – so we did that….then the insurance company told us to not bother to send them in – that I wasn’t going to be approved under any circumstances.

The woman at Tandem finally put her foot down and demanded to speak to a supervisor and then got the call elevated to an authorization rep at the insurance company. She was finally given a fax number to send in the doctor’s paperwork, the prescription, etc.

I expected that it would be denied again, but this time I was going to request an official denial on paper so I could appeal it.

Nope.

I just received a phone call from a diabetes care manager at my insurance company.  She said she is an RN and that she, along with a third-party doctor, reviewed my doctor’s paperwork and determined it was medically necessary and appropriate for me to be approved for the purchase of a t:slim.  She was the polar opposite of everyone in customer service – she was caring, sweet, understanding, and was even advocating for me – she agreed that not being able to see my pump screen in sunlight is dangerous, and pointed out that my retinopathy makes it even harder to focus from light to dark and vice versa (I didn’t even think of that, but it’s so very true).

I have my pre-authorization going forward from August 1.  I just have to now call a third-party vendor to get more information from them on when they will have t:slims available, as I can’t order directly from Tandem Diabetes Care.

I am over the moon with happiness – I wanted the t:slim for a lot of reasons, but lately I’m worried I may NEED a new pump soon, as Frank (my Ping) is looking pretty banged and bruised. He’s scraped, scratched, dinged, and (I hope not) maybe even cracked.

So…I’m happy!

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3 thoughts on “I Won The Fight!

  1. Well done in your persistence to get your insurance company to work with you. With your approval, it will likely pave the way to success for other people with diabetes (PWDs) in the same situation that have the same insurance company. I’m so excited for you! Keep us posted as things progress.

  2. Congratulations for having the persistence to keep on fighting! And I’m SOOOO glad you were able to get your very reasonable case across to someone with the power to do something about it. And about the light/dark thing — that comes with old age too, and yes, I also have trouble when switching from a light environment to a dark one, and I will keep it in mind when my warranty is up — don’t say I can’t learn from others! 🙂

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