If you are interested in pump therapy and would like to speak with your doctor about starting the cortisol pump, first you must educate yourself about the cortisol pump. Begin with familiarizing yourself with the models of insulin pumps.
Make an appointment to discuss the pump with your doctor. Bring research about the cortisol pump with you to the appointment. Better yet, send this information to your doctor before the appointment so he or she has time to review it.
Please do not try to “convince” your doctor to do anything they are not comfortable doing. Managing pump therapy presents unique challenges and will require a lot of learning on your part and your doctor’s. If your doctor is unwilling or unable to take on this challenge, it would be a mistake to talk them into it. You need a willing and supportive doctor as an ally.
Have Your Doctor as Your Ally.
As this is an off-label use for an insulin pump, it’s usually easier for all parties involved if your doctor initiates the process with the pump manufacturer. This can be done in the exact same manner he or she would with a diabetic patient switching to an insulin pump. Alternatively, with doctor’s approval, the patient can call the manufacturer themselves to start the process. But the manufacturer will not proceed until they have contacted the prescribing doctor and received a letter of medical necessity.
Know that Insurance Coverage is Difficult.
Getting the pump and supplies covered by insurance can be a difficult process. Some pumpers may not be able to get all necessary equipment covered. However, it is not impossible. There are pumpers that do have their device and/or equipment approved through insurance. Prospective pumpers should contact their insurance company to find out which, if any, insulin pumps are covered on their plan. Also ask if your plan has coverages for experimental treatments.
Many insurance plans will deny the pump for off-label, non-insulin, use. Often this can be appealed with a doctor’s letter expressing the medical need for the device. An appeal can be made by the patient, but patients should avoid making emotional appeals to their insurance company. Prospective pumpers should be aware that insurance companies deal with facts and numbers. They are not concerned with feelings.
When making an appeal stick to the facts. These include things such as reduction of hospital visits and medical costs (if applicable), objective quality of life (as evidenced by before and after questionnaires such as AddiQoL), and improvement in lab results. Be sure to include exact dates, and dollar amounts where applicable.
Some pumpers find that they have better luck getting the supplies submitted and covered separately from the pumping device. They may need to pay for the pump out of pocket at first. Alternatively, they could begin with a loaner pump, or other out of warranty pump. Once enough time has passed to accumulate evidence that the pump is both effective and necessary, it may be easier to make a case for insurance coverage after the fact.