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How Patients Can Meet the Criteria for Insulin Pump Therapy
Date:4/8/2008

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Criteria to Meet

Most health insurers and third-party payers will reimburse for an insulin pump if the patient meets specific criteria. They require that the patient has type 1 diabetes (or at least is insulinopenic by c-peptide, medicare criteria with a c-peptide less than 110 percent of the upper limit of normal with a simultaneous glucose of less than 225 mg/dl). In addition, a patient must be under the care of an endocrinologist who manages patients on pumps. And, the patient must be taking at least four shots of insulin a day, monitoring their blood sugars at least four times a day and still not meeting glycemic control goals. Usually these goals are:

-- having an A1C (also known as glycated hemoglobin or HbA1c) of less

than 7 percent,

-- avoiding hypoglycemia and

-- avoiding high morning blood sugars (also called dawn phenomenon).

"A patient also needs to complete an education program that usually includes how to use and operate the pump and perform carbohydrate counting," said Dr. Freedman. "Few patients with type 1 diabetes mellitus meet all three of theses goals all the time. So the decision usually comes down to determining whether the patient has been on a reasonable insulin regimen and is compliant with home monitoring."

The biggest challenge that endocrinologists face today is convincing health insurers and third-party payers about the benefits of pump technology. However, this is becoming easier because increasingly studies show the benefits of controlling the frequency of hypoglycemia and hyperglycemia, as well as improving A1C values.

For more information on leading-edge treatments and their medical necessity, check out http://www.allmedmd.com/peerpoints/cuttingedge/cutting_edge_email.htm. To find out more about the medical review services that IROs offer, go to AllMed's Websit
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SOURCE AllMed Healthcare Management
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