Tuesday, July 01, 2008

REQUEST FOR CGMS: DENIED BY INSURANCE

I haven't mentioned this here, but I recently decided to start a Diabetes blog too. I was never sure I could keep up with two blogs (I'm still not sure I can), but I decided having a separate blog where I can talk about life with diabetes and all that goes along with it (some good, some bad), might be a really good thing. But since diabetes is such a big part of my life, you'll still see some D-Stuff here too. Like today . . . Gina has had the wonderful idea that we all raise our voices and let the insurance companies know how much we need them to approve requests for CGMs.

A Continuous Glucose Monitoring System is a device designed to constantly check and track your blood glucose levels. It can not correct for a high or low reading, but it can sound an alarm when your blood sugar is off. At this time, it is not a replacement for the "finger stick" method of blood glucose checking, but is meant to work in conjunction with it and make it easier to keep an eye on BG levels. The technology is still quite new - with the bugs and glitches that we know is par for the course with any new technology. Because of that, along with the cost factor associated with a CGMS, most insurance companies are denying coverage. Even some insurance companies who had approved coverage in the past are reversing their decisions and letting people know they won't be covered any more. The post from my diabetes blog continues below:


I've been on my pump for about 2 1/2 months. Before I took the plunge, I couldn't see how the "new" pump technology could really help me any more than taking injections. After all, both have the same end result - getting insulin into my body. Now, as a pumper, I can attest to how much better this little piece of technology is. My blood sugars have never been better (although I hate to say that for fear of jinxing myself and ending up with a boat-load of highs - I think it will take a while before I get more confident that control this good can last). Pumping has also made my life much easier in ways I never could have imagined.

So what does that have to do with Continuous Glucose Monitors? Well, like the pump, in the not so distant past I had no desire to try a CGMS. I figured why mess with what I know - finger sticks? How could a CGMS be any better, especially since the technology is new and all the kinks have not been worked out yet?

Well, my views on CGM have changed in the last 2 1/2 months as well. I can see how, even if right now they are not always 100% accurate, a CGM can help control immensely. They help spot trends and pinpoint times of the day when a basal tweak may be necessary. They work hard in the over-night hours, when I'd be asleep and less likely to catch a low - ready to sound the alarm if my blood sugar starts to crash. I am sure a CGMS would make my life easier in ways I could never have imagined - just like my pump. So I am very upset to know that if my doctor agrees with me that I am ready to start on one, chances are good the the insurance company will jinx it.

I have had an important point ingrained into me over and over - the most important thing a diabetic can do to stay healthy is to check blood sugar often and keep it under control. This is the best way to fend off complications and live a long and healthy life. Yes, the cost of a CGMS is not small - but the insurance companies need to understand that the costs are much smaller than the cost of managing and treating diabetes complications. And on a personal level. the costs are nothing compared to the improved quality of life a CGMS can bring me.

I did not ask for this disease. It's something I was dealt, and I live with it every day and work constantly to manage it the best I can.

I did not ask for this disease. But you can bet I'm ready to ask for anything that will help me manage it. Don't deny me that right.

14 comments:

knitseashore said...

Dealing with insurance companies when you need something is really frustrating.

I'm not clear from the post -- is this a campaign for awareness only, or would you like us to email our insurance companies and request they pay for the monitor for patients? Please let us know what you need.

Nancy said...

It shouldn't matter whether or not you have insurance or how "good" your insurance is - everyone should have access to every life saving/enhancing thing medical science has to offer. Period.

Jennifer said...

Insurance companies sometimes can't see beyong their bottom line. Preventative care like the pump will be a bigger expense up front, but will save dollars later. Now, if they would just understand that...

La Cabeza Grande said...

Considering that insurance companies are really more interested in *not* paying out anything, it's a wonder anything makes it through their weeding out process.

Best of luck to you in this effort. Having my own denials and paperwork battles gives me some perspective on yours.

Denise said...

Karen, I am sorry about the denial. I am still waiting after six weeks to hear if our insurance has approved an insulin pump for my newly diagnosed 15 year old daughter. CGMS in her future? I don't know...one step at a time.
I'm glad I stumbled upon your blog - I am a knitter too AND we live in southeastern CT. Where are you located?

Jessica said...

What La Cabeza Grande said. It really makes you wonder if *anyone* in the insurance biz has half a brain cell.

Ariel said...

I felt like hollering "Can I get an amen!" out loud in my cubicle after finishing reading this post. Best of luck - you keep fighting the good fight!

cpurl17 said...

Sigh. Hang in there.

Kathy said...

I feel terrible for you. You are brave and have helped so many just by sharing your story. IM so sorry

Sonya said...

Health insurance is such a racket. I hope things turn around. It seems on issues like this that we just have to loud and persistent. Thank you for blogging about the issue!

Sourire11 said...

Ugh. How frustrating - I can't belive how backwards the insurance company reasoning is... stay strong.

guiltypleasures said...

How completely typical of insurance companies. Makes me so mad!

Anonymous said...

I just want to add my support. I'm blessed enough to have good insurance, but my late mother had to choose between diabetes supplies and other necessities.

May I suggest that if anyone ever gets a supply of this or that (I constantly have more lancets sent to me than I use.) donate it to a food pantry or community health center. Locally I have to give it to my doctor's office, where they check it all for expiration date,etc.

Alisha said...

It is not right that your not getting anything and everything that could make this all easier and keep you as healthy as possible.

I hope your able to somehow get the monitor.

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