So my daughter's Tricare finally went through and has been backdated to her date of birth. Since she was hospitalized last month for four days, she has already met her deductible and out of pocket max so we would not have to pay anything for her pump and supplies until her deductible starts over again in October. So exciting, right? Wrong... now I'm finding out that Tricare requires patients to be on insulin therapy of at least 4 injections per day for at least six months before they will approve a pump. My daughter was just diagnosed on Jan 27th, so not even a month ago. Does anyone have any experience with this and know if there is any way of getting around it? The rep is going to try to get auth anyway and see if they'll approve it since she is a child.... Don't know if that'll work but I SOOO wish it will.
That is pretty normal. Most doctors want to wait 6 months to see how your control is going. My daughter had her pump right at about the 6 moth point so it is possible to start the work earlier.
I'm pretty sure they don't want you to start off with the pump right away so you know how to give injections in the event the pump should fail. There's other things that factor into it as well.. A1C level, Age...
Sorry to hear about your daughter's recent diagnosis. Every insurance is different and not all require this 6 mo waiting period. Our pump and CGM were approved in month 3, no questions asked. Good luck, I hope it works out.
Based on our own experience, it really is better if you do MDI for at LEAST 6 months before going to a pump. Our own Ped Endo (who I trust absolutely) will not even begin discussing a pump until the primary caregiver (usually mom) has been through basic D-management classes, and they have been successfully managing their child's D for at least six months.
D management is soooo complex, there are so many variable and factors. You really have to have a firm grasp on all elements of D management with MDI before you consider transitioning to a pump. The pump can seem like the solution to all of your D-problems, but really, in many ways, it takes more maintenance and at least as much knowledge and skill to manage successfully. You have to REALLY understand so many aspects of diabetes before you can begin to pump and be successful with it.
Our personal experience with our (now) 10-year old son: pumping simply did not fit well for us. It was really convenient in many ways, but much more inconvenient in other ways. You're dealing with technology that WILL fail, whether it is a site that does not sit well, a canula that gets clogged or slips out, or a control device that fails. We had sooooo many sites that failed and had to be replaced before the "three days" mark, and two controllers fail...one while we were camping where there was no cell phone service, and no way of getting a replacement controller within a few days time. By the time the 2nd controller failed, it was clear that MDI was soooooo much better for our son.
So, based on our experience, please try to be patient. And realize that, while pumping is GREAT for a LOT of people, it still comes with it's own set of challenges. AND, it doesn't work out for everyone.
My son's doctor also felt that we need to wait at least 6 months from day of diagnosis until we can consider a pump and now we are going through 4-6 months of training before he can get the pump (and I just started the pump myself 1 month ago but this does not matter even if I have been trained already).
Since the first year of diabetes is the hardest and most challenges I believe that is why they sometimes have kids wait for the whole family to have a better understanding of diabetes management before throwing in something complicated albeit a great invention such as the insulin pump.
As well, it is best to learn how to do MDI's since sometimes when you have issues with the pump you must revert back to MDI's (temporarily) so this is important. As well, maybe they want to wait until the honeymoon period has passed.
Wow, you must be so disappointed. I don't feel that the six months are necessary, although familiarity with all aspects of diabetes is.
Just hold on tight, and believe that the pump will change your child's life when she gets it. As my seven year old son said (after his initial adjustment to the pump), "I feel free again!"
Have you discussed with your Endo on whether a pump is even optional? Your post didn't mention what your doctor's thoughts were on the matter. We were told by our Endo that a pump wouldn't even be discussed until we had successfully managed his diabetes for at least 6 months - 1 year because of the constant changes. These past 5 months (since diagnosis) have been like a roller-coaster ride since he is officially "honeymooning." They've changed his Lantus 6 times, and his carb ratios during the day have become nearly non-existent. This may very well be a reason that the insurance wants to wait on your pump, or they may need to make sure you have a good grasp on how to handle things without the pump first. And I'm sorry, but as a parent with a recently-diagnosed T1D myself, I don't believe one month is near long enough time to learn what to do on your own before relying on a pump. We still have things to learn and it's been 5 months. I know it's frustrating but please be patient.
Every endo is different, diabetes varies among children, not everyone honeymoons, lets give this mom a break. Our office pushes the pump right away. We all know endos arent always right, insurance can be a pain in the ass, etc. etc. Many, many kids start on a pump within mere months of diagnosis. Some people take years before they are ready for the pump, you do what is best for your child. In the short 4 mos since my son's diagnosis I have learned that even the most well meaning endos often dont give advice based on my son's unique set of circumstances, but just on what is done in their office. We had to insist on getting a cgm without support from our endo, who wanted us to pump first. Meanwhile, it has caught so many lows we may not have. And our son has adjusted very well to MDI so we have postponed our pump start. We all do what works for us. I hope you are able to getthe pump worked out Antonette.
I agree rhooker. We are 5 months in too and I think the first question out of my mouth when we were in hospital was "when can we start her on a pump" Now the MDI seems to (finally!) be doing a great job and I am not so insistant on it anymore. I would, one day, like a pump to get away from the rigidity of schedule and get some flexability back, but for now I am happy to wait the 6mos-year that is reccommended. As long as my daughter's BG are where they need to be, and she seems to not mind MDI, we are happy! And who knows, a parent may end up pushing for a pump only to get one and find the child is not keen on wearing one 24/7. (I often wonder if my 3yr old would leave it alone or it would get pulled off lots)
I'm active duty with Tricare Prime and I don't pay anything for my daughter's supplies. Perhaps you guys are Tricare standard?? I have to agree that the family should have a few months of shots under their belt before the pump to feel comfortable doing shots in the event of a pump malfunction and in our case we weren't counting carbs at first b/c my daughter was so small and didn't eat enough. Given that, we had to have carb counting down pat before our Endo would even consider switching us. Now we've been on the Omnipod for 6 months and life has truly changed for the better! I hope you're getting closer to making the switch too! I know my pump company has a rep that specifically works with Tricare and as long as the dr says it's medically necessary to bring the BG back under control it hasn't been an issue. Good luck!!
If my son had been a few months older at dx, we could have walked out of the hospital with a pump. I think I could have probably pushed for it if my husband was not so hesitant. As it was, we waited for 5 months, but our clinic supported pumping as soon as we were ready and our insurance did not put up a fuss.
I strongly disagree that you need to wait 6 months. Yes, you need to know how to deal with shots in case of a pump failure and you need to be able to count carbs, but those are not difficult things to learn (in fact, we did not count carbs or deal with carb ratios until the day we started pumping). A pump is just a different delivery system, not a scary magic box, and as long as you are in the midst of a major diabetes learning curve, you might as well learn about the pump at the same time. Plus, the pump makes small doses easy to manage, so it is good for a kid on a honeymoon.
I say, if you want to pump and feel that you are ready, and if your endo/clinic support you, ask them to write a letter of medical necessity and see if they can get the gears moving a bit faster.
Oops--I just noticed how old the original post was! OP, I hope things worked out!