Form letter to ask employer for insulin pump coverage

I wrote this letter to my HR department because my employer doesn't provide coverage for insulin pumps or supplies. They responded by saying they will make an exception for me and look into adding coverage for all employees when they re-negotiate the plan with our insurer next year.

I took the letter I wrote and made a generic form letter for you to use if you have the same problem.

Some things I've learned from this process:

- It helps to show medical need and provide supporting info from your doctor

- It helps to show any other coverage you have that you could co-ordinate

- I emphasized the fact that pumps are usually used by T1s, which is a much smaller population that T2s. I did this to show that adding coverage won't have a significant impact on their claims costs. For the same reason, I highlighted the fact that On and BC public health covers pumps because I work for a national employer.

- Never purchase something before you get approval. Employers won't pay costs retro-actively even if they add coverage in the future.

Subject: Please add insulin pumps and supplies to health plan coverage

Dear HR person:

I recently learned that my health plan does not cover insulin pumps and supplies. Using an insulin pump, rather than injecting insulin up to six or more times per day, would improve my health, reduce the amount of time I spend away from my desk and help me better manage my Type 1 diabetes. I’m writing to ask you to add insulin pumps and supplies to the health plan coverage for the upcoming plan year.

Why pump coverage is needed

I was diagnosed with Type 1 (Juvenile) diabetes in 2009. Type 1 diabetes occurs when your body’s immune system attacks your pancreas, leaving you insulin-dependent for life. It is not preventable and it is not related to lifestyle or diet. Only 10% of all diabetics have Type 1.

Since I was diagnosed, I have been controlling my blood sugars through multiple daily injections (MDI). Despite trying out a number of insulin programs, my endocrinologist and I have been unable to find an injectable insulin that matches my body’s blood sugar peaks and valleys close enough. As a result, I spend a portion of each day with high blood sugars. These portions of time add up. Over the short-term they make me far less able to fight colds and infections, and I take more time to heal than a healthy person does. Over the long-term, they lead to complications such as blindness, amputations, heart disease and kidney failure.

A pump can improve my health

My endocrinologist recommends I begin using an insulin pump to better control my blood sugars. An insulin pump is a palm-size device that delivers steady doses of insulin into the body. It is best suited for diabetics who need insulin to survive — Type 1 diabetics and some Type 2 diabetics.

Insulin pump therapy is the ‘gold standard’ treatment for diabetics who need insulin replacement, according “Diabetes in the Workplace” a report that Benefits Canada released in September. The report says compared to MDI, pumps have been found to:

· reduce blood sugar spikes and dips

· decrease the number of low blood sugar episodes

· lower A1c values (three-month blood sugar averages)

As a result, employees are healthier and less likely to take time off work.

MDI requires four to six injections per day and testing eight times per day. To do this, I often must excuse myself from a meeting or break from work to test my blood sugar, eat or inject insulin. Using an insulin pump could significantly reduce these interruptions because the insulin infusion can be controlled by a hand-held wireless device. This gives me the freedom to discreetly increase or decrease my insulin as needed and to eat when I am hungry, not when a low blood sugar dictates it.

You can help

Insulin pumps can cost between $5,000 to $7,000 and monthly supplies range from $150 to $300. Our health plan does not cover insulin pumps or supplies. And although B.C.’s and Ontario’s public health programs cover insulin pumps, Alberta’s does not.

I coordinate coverage under my husband’s student plan at >> and have coverage for both the purchase of an insulin pump and the supply costs. His coverage ends early next year when he graduates from school.

Without coverage from my employer, I’m left with the difficult decision of either placing a significant financial burden on my family in order to have the best care for my disease or following the only treatment my health plan covers and continue to suffer poor health despite a proper diet and regular exercise.

I’m asking you to add insulin pump and supplies coverage to our health plan to support the well-being of employees like me.

Sincerely,

Views: 117

Tags: alberta, coverage, insulin, insurance, letter, lobby, pump, supplies

Comment by Donna H on October 31, 2010 at 7:27am
GOOD FOR YOU!!! Sometimes just speaking up can move mountains.
Comment by Linda on November 1, 2010 at 8:12am
Good letter! I hope you will get results. I have been through the same problems with our group insurance. I did finally(after two years), get the insurance to cover by CGM as a stand-alone on my major medical. Still can't get any supplies, etc with my drug card. $25 co-pay on drugs, 20% after meeting deductible on Major Med. There is quite a difference! Why do insurance companies not see that control & good care is far better than the alternatives?

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