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Does medicaid pay for insulin pumps?


I was hoping someone can help me find out if Medicaid in NY pays for insulin pumps? My blood sugars are very bad. I know I need to get stable first but want to get his after? Any advice?

Yes, it looks like they do. Here's what I found on the New York State Health Department website:

The primary goal of diabetes management is to maintain near normal glycemic levels to achieve maximum prevention of complications.The American Diabetes Association recommends maintenance of an HbA1c of <7%, while in August 2001,, the American College of Endocrinology and the American Association of Clinical Endocrinologists lowered their target for glycemic control to 6.5% HbA1c. The use of insulin pump therapy, in selected patients, facilitates maintenance of tight glycemic control.

The pump delivers insulin in a more physiologic manner. The delivery of insulin is in small, continuous amounts, much like the pancreas. Insulin pumps use only fast acting insulin, much like the body produces. The delivery is accurate and consistent. The insulin delivery can be better matched to patient need for:

Basal Rate: slow, continuous infusion of insulin to cover the background insulin requirements.
Bolus: a larger amount of insulin delivered "now" like an injection, to cover a meal or to correct a high blood sugar.
Pumps are especially helpful for the following indications: poor HbA1c control, frequent hypoglycemia such as "dawn" or "Somogyi" phenomenon, anyone who is active or athletic, has a demanding lifestyle, does shift work, is planning a pregnancy, or has complications such as gastroparesis. A patient is a candidate for an insulin pump if he or she is motivated to achieve better blood sugar control and is willing to follow through with a diabetes treatment plan (q.i.d. blood sugar testing), a meal plan and makes most of their scheduled appointments.

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IInsulin pumps are covered by the Medicaid Program as durable medical equipment via prior approval using code E0784 External ambulatory infusion pump, insulin based on medical necessity and appropriateness of care. Orders for insulin pumps must originate from an endocrinologist.

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For information on obtaining prior approval for an insulin pump, please contact the Bureau of Medical Review and Payment's Prior Approval Unit at (518) 474-8161.

For additional information regarding Medicaid payment on other medically necessary care, services and supplies for the diagnosis and treatment of diabetes, please contact the Bureau of Program Guidance at 518 474-9219.

Some peoples insurance pays for most of the insulin pumps, others don't. I know you have type 1, or insulin dependent Diabetes, any ways get your bg sugars under control then start thinking about the pump.

I have an insulin pump and got it because my sugars weren't under control. I am now on a medical card and it was a pain to get them to even cover the supplies. I know one person though that got the pump covered by medicare but it was because she was 13 and diabetic since birth with under sized kidneys and insulin resistance. She is doing better on the pump but is the only case I know that was approved!

I work in a doctor's office in NY. None of our diabetic patients have ever been approved for a pump, though someone who was already on a pump and needed Medicaid when their insurance ran out, was able to continue getting their supplies. Despite what their website may say, Medicaid only pays for necessary items, and oftentimes they feel insulin and needles are sufficient.

I live in NY am on medicaid and am diabetic and using the pump. Yes medicaid covers the pump and its supplies. good luck

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