Apr
While many health plan insurers will pay for patients with type 1 diabetes mellitus to have an insulin pump, the criteria for approval is not always clear.
"Continuous subcutaneous insulin infusion (CSII) or insulin pump therapy is an ideal tool for the patient in need of intensive insulin therapy and carbohydrate counting," explains Dr. Skip Freedman, Executive Medical Director at AllMed Healthcare Management, a leading independent review organization (IRO). "But>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.