People who feel a bit anxious about using such an expensive piece of medical equipment, take note: Your insulin pump can be covered by a renter's or homeowner's insurance policy. Insurance companies will issue a special floater, as they would for an expensive piece of jewelry.

It seems like all I do is fight with my insurance company over how many blood sugar test strips I can get a month. I don't know if I have the energy to take on another battle with pump supplies.

Again: Knowledge is power. The bureaucracy of managed health care can be mind-boggling; still with a little effort, you should be able to break through the red tape and reach a real live person. Ask to speak with a manager or head of department; find out exactly what your insurance will cover. More and more, many American states are mandating coverage for diabetes supplies and this will cover the insulin pump and pump supplies. Fortunately, Medicare now covers the cost of the insulin pump for people with type 1 diabetes.

What is even better is that the major pump manufacturers-Animas, Disetronic, Medtronic MiniMed, and Sooil-all have trained professionals on their staff, whose entire job is to advocate for you to your insurance company. They know which companies are easy to deal with, which are more difficult, and how to convince them that the insulin pump is a medical necessity for you. Slowly, insurance companies are realizing that in the long run, they will save tremendous amounts of money if people with diabetes can achieve optimal blood sugar control and so avoid complications. As stated, insulin pump therapy has proven to be key in tight control.

Kathy Kochan remembers that when she ordered her insulin pump six years ago, it took a good six months for her to get insurance approval. "I was ready to go, but I had to sit around and wait for the insurance to get straightened out," she recalls. Fortunately, most pump companies are able to work with insurance companies so there is only a two- to three- week delay from the time you make your decision to pump.

Interestingly enough, there appears to be a correlation between people living in countries with managed health care, in which money is not an issue around supplies, and good diabetes control. Disetronic is a Swiss-based company with large markets in Western Europe. Their studies show that people living in Scandinavia, the Netherlands, Germany, and France-for whom getting on pump therapy involves very little red tape-have an 85 percent better rate of optimal diabetes control than people living with diabetes in the United States. Medtronic MiniMed has a majority share of the insulin pump market in such countries as Italy and Israel, and finds the same to be true there. For being the "richest" country in the world, the United States has much to learn about providing adequate health care for all. Sadly, in developing countries with very poor health care systems, pump therapy is virtually nonexistent in the present time.

By the way, if you are a citizen of the United Kingdom and are concerned about medical coverage for your pump, check out the Web site www.insulin-pumpers.org.uk. This site includes lots of good information about how to best work with the health care system there, to insure financing of your pump.

I've been approved by my insurance to get started on a pump. But I'm worried that my insurance will give me problems about the monthly supplies, which seem pretty hefty. And what if I change jobs. What then?

There is no doubt that for most American citizens, dealing with insurance issues can create many headaches. When it comes to pump therapy, there may be problems that arise.

Mort Waldbaum is now well adjusted to life with the pump but is still struggling with Medicare. "Medicare allows me thirty infusion sets for ninety days," Mort explains. "But I'm on a heart defibrillator that takes up room where my insertion sites would be. When I'm looking for a good site, I could go through 2 to 3 sets each time I try to insert one. And Medicare won't pay the difference." Especially for senior citizens living on a fixed income, this kind of challenge can be daunting.

Changing jobs can also cause insurance nightmares. Carys Price recalls the outcome of a job change. "It was a major headache. Getting my pump supplies with my new insurance became the biggest headache in the world. I would order supplies from one of these big companies, and wait and wait. Where are these people? When you call and leave them a message, they don't call back," she reports.

Eventually, Carys got her annoying insurance situation straightened out, but not without a good deal of energy and effort. I've gone through three insurance changes during my three and a half years on the pump, and fortunately, I can't complain. Again, since the pump companies have professionals on board who will do the legwork for you, I give it over to them and let them handle it. I've had success every time.

One more bit of good news: Insulin pumps are constantly improving with better technology, and most insurance companies will approve you for a brand-new insulin pump every four to five years. Again, check with your company to find out their policy on upgrading pumps.

My doctor wants me to go on an insulin pump, but my husband recently got laid off from his job and we're going to lose our health care coverage. I don't know when we'll get new insurance. How can I consider taking my doctor's advice?

For people without insurance or with plans with inadequate coverage, don't despair. Contact your local ADA or JDRF and find out about financial assistance for pump users. Also, both the Lions Club and the Rotary Club, in certain areas, offer scholarships to help pay for pumps. In Canada, a special charity called S.U.G.A.R. helps people pay for pumps; you can find them on-line at www.sugarcharity.org.

I've heard about people without health insurance who have done fund-raisers to help earn money to buy a pump. At some point or another, most of us have to ask for help with something in our lives. You may be surprised by how many people would be willing to donate a few dollars to the cost of your pump. I know how hard it is to ask for help. But above everything-even your pride-should be concern for your health.

You may also want to explore getting a DANA pump from Sooil, a Korea-based manufacturer. Sooil has recently opened their market to the United States and Western Europe, and is willing to offer a special payment plan through some distributors. Go to www.danapumps.com for more information.

But suppose my pump just breaks one day, or what if I have a freak accident. Is my insurance company going to pay for another pump?

Should anything happen to your pump, you have no worries. All of the major pump companies offer a four-year warranty, which means that they will replace your pump at no cost to you. Remember, after four years you are eligible for a pump upgrade, so once you get your new pump, you will then have a new four-year warranty.

Talk with the manufacturer of the pump you are interested in purchasing and become clear on its policy. All of the companies will strive to replace your pump within twenty-four hours; some will even have a customer service representative drive a pump out to you so that your wait is only a few hours long. Interestingly enough, Disetronic's top-selling pump is still the H-Tron Plus, even though a newer model, the D-Tron comes with more sophisticated features. The reason for the H-Tron's popularity is that when you order one, you receive two pumps automatically, so you would never have to switch back to injection therapy (even for a few hours) if you lost or broke your pump. Other companies, such as Animas, will lend you a second pump if you plan to travel overseas or have a child going away to camp. When you (or your child) return from wherever it is, you simply have to return the back-up pump to them. That's what I call service!

From the book Insulin Pump Therapy Demystified
Copyright © 2003 by Gabrielle Kaplan-Meyer
Appears by permission of publisher, Marlowe & Company, a division of Avalon Publishing Group.

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