My 13 month-long fight with my insurance company has taken a beautiful turn for the better. The third level of my appeal process was sent to an independent review organization (IRO) last month. The list of items sent included 39 documents, ranging from my bg charts, endo’s prescription and letter of medical necessity, academic articles and all the previous correspondences I’ve had with Regence.
I received a letter from the IRO yesterday saying, “It is the recommendation of this reviewer that the denial of coverage issued by Regence BlueCross BlueShield of Oregon for the Glucose Monitoring System is overturned.”
Here is another quote from the letter that I’d like to share:
“Even though CGMS in general is not considered the standard of care, in evaluating this specific case, CGMS would be considered the standard of care by the medical community. It would not be considered experimental because greater control of her glucose would result in improved health outcomes compared to standard therapy. The greatest potential for the CGMS with this enrollee is to monitor trend of variations in glucose rather than simply the highs and lows in blood sugar. CGMS can provide the trend of glucose excursion. This patient is prone to hypoglycemia unawareness. This feature in the Paradigm Real Time system could be valuable for her to identify hypoglycemia trend, thus allowing her to make an adjustment before a hypoglycemia event actually happens. In addition, there is an alert system in the machine that will alert the patient of hypoglycemia. The sensors features on the Paradigm Insulin pump will likely improve her glucose control, HbA1c and safety.”
Please feel free to contact me, share this news, reference this blog or whatever you need to help your own fight. May we ALL enjoy what should be the standard of care for our diabetes management, without having to go through the rather grueling process of appeals.
THANK YOU to TuDiabetes members Marci and Rick for their input, it proved invaluable. Thank you to all the TuDiabetes members who encouraged me to continue this long and weary battle. Thanks to my family, especially my husband Michael who wasn’t so sure my tenacity would actually convince the insurance company, but he encouraged me to continue anyway.
Now, I just need to continue my diligence and patience - Regence should be contacting me soon. Maybe I’ll just go ahead and call them!! I’m so thrilled to have won!! What a day for a personal victory, the first day of the Olympics!