What to Do When You Need to Change Treatments
“For years, I used the same insulin pump. When my doctor told me that I would benefit from a different one, I wasn’t exactly sure how to handle that with my insurance. My colleague told me to check my policy—and I was glad I did! When the policy was confusing, I followed up with my insurance company and they explained that the newer pump was not covered, but I could apply for an exception. Because my doctor could show that it was medically necessary, the exception was granted.”
—T1D patient, AZ
In this section we’ll discuss
What to Do When Switching Insulin Types or Treatments
There are several steps to take once you and your doctor have decided that switching diabetes treatments is best for you. First, review your policy. If the language is not clear whether the new treatment is covered, call your human resources department or health insurance company (there should be a member services number on the back of your card). It is important to check the coverage status of the specific brand of insulin, insulin pump or continuous glucose monitor (CGM). If the new treatment is not covered, you can request an exception. Keep in mind that your doctor will need a medical reason to back up a request for a coverage exception.
Your Options for Switching Treatments
|IF TREATMENT IS COVERED||IF TREATMENT IS NOT COVERED|
In this case, it likely won’t be an issue to switch, but you’ll want to consider a few things:
In this case, you’ll want to consider a few things:
JDRF maintains a forum where insurance issues can be discussed.
If you have questions for the community, you can post them here!
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