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Update on CGMS Denial Day: They’re Listening!

July 4th, 2008

CGMS denied

They hear us. I am getting emails from people telling me that insurance just approved them for the CGMS.

***I urge you all to keep raising your voice, send your denial blog post link or denial story to me gcapone1 (at) optonline (dot) net, Please put CGMS DENIAL in the Subject line *** Together we can make a difference.

Yesterday I sent out a press release about CGMS Denial Day to prweb.com, and some other media contacts. Within the hour of sending I got a call from Diabetes Health Magazine that they wanted to do a story. I was very happy about this because I was not sure if any media would cover this event. Diabetes Self Management covered it in their section What We’re Reading. Amy Tenderich of Diabetesmine.com did a story called Paying for CGMS day.

Here are some bloggers that contributed:

Katie I: I sought coverage from United Health Care for my CGMS that accompanies the Minimed Paradigm 722. UHC denied coverage, and I paid out of pocket for the cost of the CGMS.

Your Diabetes May Vary: Guess What? We got denied!

Sixuntilme: I submitted the paperwork when I applied, But my CGM coverage was flat-out denied.

Pumped Up: I know the CGMS would benefit me greatly. It would show trends that I have tried to “see” for myself.

Journal Diary Blog: This BLOG is In awareness of diabetics being denied from their insurance companies in regards to obtaining a Continuos Glucose Monitoring System (CGM) – a dedicated day has been initiated.

Floating Down the Karpoozi River: I wake up, feeling disoriented, dizzy, confused, and shaky. It’s a feeling that I unfortunately know well.

Angie Ravenscroft: I had my 8 year old daughter post her thoughts on our blog.

Bittersweet: 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.

Windy: My coverage has been pending, and pending, and pending, and pending….

NIck: My insurance pays for CGMS for me and my daughter, but that doesn’t mean I am immune or blind to the outrageous denial of this wonderful technology by insurance companies.

George Simmons: Watch the video and see what CGMS is and why insurance thinks we do not need it.
Strugle for the system:
I want to be healthy. I want to live as long as I can. I want to be complication free.

Bunny Kissed: This is not something I need right now, as my diabetes is not severe and kept under control quite well with medication, but there are many diabetics who really could use this, and maybe someday I will too.

Michelle Curtis: This technology is amazing and it isn’t “Cadillac Care” as some have referred to it. Having a continuous glucose monitor, which reads your “blood sugar” every 5 minutes, is like dealing with diabetes with the lights on rather than in the dark.

Penny: I just wanted to say that I too am a victim of the CGMS Denial SCAM by the insurance companies! I have lived with Type 1 for over 23 years now and my current A1C is 7.4. Blue Cross denied me the CGMS by stating that I am in “too good of control”… WHAT??? I thought that if your A1C was not under 7.0 that you still had some work to do in order to be under good control. Granted that my A1C is much better than some, I still cannot believe that the insurance companies can get away with this excuse! It’s time that the insurance companies take the PROactive approach to diabetes care as all of us do and cover things early in our treatment instead of waiting until we have the complications such as blindness, heart attack, stroke, amputations, or worse. The insurance companies would spend less money if they covered these newer technologies up front. I guarantee you that the cost of covering the CGMS is far less than that a few days stay in the hospital for something that would be avoided by using the CGMS.

Kaileen: We start this blog on CGMS Denial Day. We do not have a CGMS: however, lives can be changed and saved by using this one powerful tool.

Priscilla Call Essert: I have been hesitant to really throw myself into this blog. Now that CGM Denial Day is here, I have decided it is time to throw caution to the wind and just get going with it all. So I will kick this off with our denial story.

Honeysweet

Shannon: Like so many others, I’ve been denied coverage for a CGMS. As a diabetic hoping to start a family very soon, I need constant monitoring of my blood sugar.

Kathleen Weaver: I’ve never been denied, officially but my paperwork was completely ignored. Disappeared off the website.

Mick: I have been both personally and professionally affected by the ongoing denial of CGM coverage by medical insurance companies.

Emilie: I wanted to join others in making sure insurance companies understand that CGM coverage is medically necessary.

Marshy: Overdosed on Humalog: Free!
One mile ambulance ride to hospital: $2920.00
Hospital bill for useless tests: $33592.94
Box of ten sensors: $350

Denial of benefits: Priceless!

Nicole: We were initially denied but I won out because my husbands insurance company is self insured so I went to his boss’s. I am currently try to help a friend gain approval through her insurance company after several denials.

Staci: I call my Highmark PPO Blue provider every 2 months just to hear them tell me that my sensors for my CGMS are not covered. My doctor has asked me to write a letter so that he can also make a formal appeal.
Since I have had the CGMS my A1C’s have gone from 8′s to 6.7. That is a major drop. I have had type 1 for 47 years and the CGMS is a miracle. My insurance paid for the pump/CGMS but won’t pay for the sensors. This is ass backwards. The insurance providers need to recognize the up front cost will save them alot of money because diabetics can have better control and therefore less costly medical bills.

Lee: It is imperative that insurance companies recognize the need for the CGMS to save the lives of diabetics. I technically have had diabetes since childhood 50+ years, have hypoglycemia unawareness, have had serious lows that included seizure and unconsciousness. How close to death and how many times can this happen without the loss of the individual?Insurance companies need not discriminate. Deciding insurance parties need to be educated on the need for the CGMD. Many diabetic patients can be controlled only with CGMS effectively; to increase our chances of not having serious side effects which are extremely costly to the “system”. Early stroke, death, and the complications of diabetes which are “deadly” could be avoided if insurance companies and MDs would be advocates for the Diabetic patients. Life is priceless, neglegence and negativity costs lives.

Flying Horse Ranch: This is VERY IMPORTANT, to spread the word of Insurance Company IDIOCY.

Dorkabetic: When I want to get my own CGMS, I expect some coverage.

But wait it gets better: We stand by all those fighting the good fight.

• Sunnie: I’ve had Type 1 for 35 years and have had so many insulin reactions, concussions, etc. during the night that my endocrinologist wrote a letter of medical necessity to Blue Cross/Blue Shield when I appealed their denial of coverage for a CGMS. I wonder how many people making their decision have diabetes!

Carol:
• Since we cannot account for everything, the best we can do sometimes is react to it. A CGM will help us to react faster, and to avoid the short term disaster of a severe low behind the wheel, as well as some of the long term damage that our bodies are racking up due to BG’s that are too high as we try to avoid those lows….
• It would also help me to not lose heart in my battle to remain as healthy as I can.
• I keep my blood sugars higher than recommended sometimes because there are so many unknown variables and the lows are debilitating. In case you are wondering, it’s not a simple case of counting carbs and taking the right insulin doses. There are hormones, activity levels, and stress to try to “quantify”, which is of course impossible. That is where a CGM could really help.
• My doctor suggested I look into getting a CGM, but so far I have found that I cannot afford it.

Jim Hirsch: In Search Of Reimbursement: A CGM Odyssey

Ed: I just want to let all know that I was denied CGMS coverage back in July 2007. I wrote appeal letters from July through March of 08. My insurance company finally caved to my persistent demands back in April and are now paying for my supplies 80%. Starting this July I am starting on a new PPO plan. I may be starting over on my CGM battles. But my point is you do not give up. Often insurance companies have an appeal process that will eventually go to what is known as an external review board. These are physicians that are working outside of your insurance company. I urge all of you to read up on the appeals processes for your individual insurance companies. Knowledge is power and sooner or later the insurance companies will have to meet are demands. Remember how hard it was to get coverage for pump therapy back in the early 90s?

We didn’t give up then and we will not give up now.
Rock on,
Ed

Lanie: I am retired from the Federal Government and therefore was fortunate enough to get insurance despite Type 1 diabetes. Blue Cross/Blue Shield covered the Medtronic CGMS, but not the sensors. I am now covered by Cigna, and they just approved 90% payment for the new Freestyle Navigator I switched to, including sensors. Thank you, Cigna. I am very lucky. CGMS has made a terrific improvement in my life, alerting me to rapid and dangerous shifts in my blood glucose. It is criminal that some insurance companies make immoral decisions costing people their lives.

Greg: Insurance companies are more involved in the continued need for prescribed drugs and such than a cure for one of the top three adult causes of death. Why would they be against yet another product we (diabetics)would be hooked on for life and they could over charge us for. I guess CGMS are not cost effective for them yet which is cleverly called “experimental”.

Nulcia: I have had diabetes for what seems like forever 30 yrs and Last year I was denied…denied…denied I don’t really understand what the problem was…they pay for meters…they pay for the pump…this is simply an advance in technology. Hey…I remember when I had to pee, collect it mix it in a test tube…thats right a test tube, and that determined your glucose range. I have seen many advances and the CGM is the best so far. Insurance companies don’t have diabetes…but people sure do!!

Mary: Yes! i was one of those people. Never knew when my sugar was low. My insurance kept turning me down for the sensors, till one day i was driving and it happened.I had a major car accident and then i decided again to apply for it, only this time they approved it. My statement to them now was. Your lucky you did not have to pay thousands of dollars of medical if i had injured someone!! Its amazing how this syten works, It even wakes me up at night if i go low.Best decision i have ever made in my life.

From Diabetesmine

June S: I am wearing CGMS, and because I live ALONE and have a major (rational) phobia about nocturnal awareness, I really benefit from these sensors. They allow me to fall asleep at night. I’ve had diabetes for 36 years this month, and for most of them (excepting the first 10 years, when I had TOTAL hypoglycemia awareness, I have set my alarm for the middle of the night, or drank a glass of water (so I’d have to wake up to use the bathroom) or taken too big a snack at bedtime, out of a great fear of nocturnal hypoglycemia.
I also suffer from daytime hypoglycemia awareness. When I was first diagnosed my hands used to shake when my BG hit 75; now they don’t shake at all. I usually just start crying when my BG’s get to 60. CGMS works for me!!!!

Jeff: I just have serious problems with the insurance companies telling me what is best for me. When my doctor, CDE, and I all can agree that I would be a good candidate for a CGMS, that should be enough for the insurance company; regardless if I use it 24×7 or just a few times per month. The insurance companies are paid by people like me and the companies we work for. It would be nice if these same insurance companies would work for their customers, IE people like me.

From sixuntilme.com

• Mark: I can’t help but compare this back to the early 1900′s when animal insulin was adapted for human use. Those who were slowly dying from this disease by slow starvation and the eventual ketoacidosis of the body. Can you possibly imagine the horror for those individuals and their families to watch these deaths unfold? The horror of this disease had to have been monumental. Moreover after the “cure” was found those who had to wait until it was available for them. I can only imagine the desperation for those on the waiting list back then. We have come along way baby, but not far enough. With the real cure (assuming there can be one) still on the horizon we are left with the latest technology to live as long as one can with as few complications as possible. CGMS is the dawn of one having the consistently normal blood sugars we need. Those who make this technology and those who pay for it, must align their priorities to make this available to every type one. If those who say that is not practical I offer this up. If your own children had type 1 would that change your opinion of what is practical and needed?

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7 Responses to “Update on CGMS Denial Day: They’re Listening!”

  1. Tonya Says:

    UHC paid for my pump and CGMS. After moving to Aetna, they have refuesed me over and over again. Aetna has claimed that they haven’t received paper work that I have faxed, and certified letters from my doctors mailed to them, and not one person has a straight anwser. Until this becomes a universal treatment, I will continue to check my BG 15x a day to keep strict control.

  2. Lynn Says:

    I run a few Internet groups, and see lots of people with unawareness, and/or those who would benefit from alarms letting them (or parents) know if they are going low. I do know however, my hmo cant even yet handle filling pump prescriptions or supply orders. They dont even know what they are doing with the simple stuff. So unless they have a real education in this, they are not going to get it or make an effort to get it. I’m grateful for my supplies being covered, but I couldnt even get my last pump fully covered (had to pay 50 percent). So I dont expect much from my HMO, which is an HMO only located in one state.

  3. Dennis Says:

    Well, I think unless one is experiencing Being Hpyo Unawareness? Or some other serious Medical condition? Regular Testing is suffeicient to establish Good BG control.. Others have OCD in testing far too much.. Why? Novalog/Humalog takes upto 3 hrs to peak ( ave 25-33% hrly Increments)

    And Many Don’t know what a 2 hr Correction bolus is for themselves..so what good is testing 1 and 2 hrs after eating? If they have the correct I:CR ( insulion to Carb ratios) and stick to foods they know the Totaal Carbs? A CGM isn’t necessary..to achieve 6% A1c’s

    TheCGM isn’t as Accurate either.. constant back up Meter Testing is also required..

    I’ve been testing an ave of 8x in a 24 hr day period and have 5.5% A1c’s 9 mos a yr and 6% over winter here in Wi.

    i’d rather see the $ going for CGM’s to go for Paying for Pumps for those who Can’t Get them instead..

  4. Laurie Says:

    I dare say that Dennis is in a minority. A good A1C can result from highs and lows balancing each other out to make a good average. No two foods digest the same way, hormones and stress play a huge impact on glucose and exercise isn’t always predictable as far as glucose effect. Not to mention children going through growth spurts, women trying to have children or going through menopause, or those that have active schedules with variance and change.
    Seeing the data between finger sticks will surely reveal things you don’t think are happening or expecting. For most of us, that’s priceless. I guess some prefer to do 8 finger sticks a day…wow. I don’t ever want an A1C above 6%!

  5. Manny Hernandez Says:

    @Dennis: In pite of your phenomenal A1C (mine is 6.2), with all due respect, your argument sounds like the one made by a person representing the FDA that had a panel at the recent Friends For Life conference. I don’t think we need to look at this with a scarcity mentality: both, pumps AND CGM devices should be covered, as they are items that are bound to help reduce complications with as many issues as can still be attributed to CGMS.

    Only when there is a large number of adopters (which will only happen when there’s consistent coverage) will there be a consistent evolution in the technology leading to more and more precision in values, decrease in costs, etc.

  6. Kevin Pammett Says:

    I too am a long-time Type I diabetic with the strong opinion that CGMS is *required* for the best health result that is needed to sustain us, especially as we get older. Moreover, the more that these devices get used throughout our community, the more that product companies will invest in making and improving them.

    My stand is that allowing health insurance companies to “just say no” is no longer acceptable.

    -Kevin Pammett
    http://www.DigitalMediaMagik.com/

  7. siki? Says:

    I would also love to add that if you do not actually have an insurance policy or perhaps you do not form part of any group insurance, you might well gain from seeking the help of a health broker. Self-employed or those with medical conditions ordinarily seek the help of an health insurance dealer. Thanks for your post.

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