Has anyone wanting a CGM who has been denied coverage by their insurance
company seen this recent Consensus Statement by the American
Association of Clinical Endocrinologists? It may help in framing your
arguments to the insurance company. Based upon a variety of conditions
(frequent hypos, both high and low a1c levels, glucose control, etc.)
the association essentially acknowledges that all
persons with diabetes qualify as candidates who would potentially
benefit through CGM use. Link is posted below-large file, though! Email
copies of the link to your PCPs if you can!
PS: I am a school
nurse who has been working on a master’s degree. My loving wife would
not allow me to go away to school this past summer without a CGM,
because she knew that I’d be at risk for nighttime lows and she would
not be around to help me. My monitor worked wonders there. I had no
hypoglycemic events during 5 intense weeks of studying full-time during
the days, then doing research and writing every evening until midnight.
Acquiring the CGM turned out to be a serendipitous event, as I chose to
use the device as part of my master’s project.
After learning
about all the hassles getting insurance approval that folks documented
here, I chose to work on, “A strategy to increase the use of cgm among
school children with diabetes.” I’d love to hear any input from tuD
users related to their trials either with obtaining, learning about or
trying to teach their school nurses how to interpret (or not freak out
over) CGM results. Please post your experiences in response to this
discussion. For those who are expert with this site, can you tell me
whether this is the best way to access input from users? I may also be
interested in posting a survey on the site. Is that easy to do? (I’m a
bit late for that approach because my rough project must be finished by
December 10.)
Thanks to all for any help that you can provide!
http://www.aace.com/pub/pdf/Continuous’GlucoseMonitoring.pdf
My son is on the Dexcom and we love it. However, because he is 10, we don’t teach the teacher or the school nurse to use it - I am usually using it for my own benefit of adjusting his pump settings and learning (and teaching him) how different foods and activities affect his bgs during the day. For instance, he usually eats a pretty balanced breakfast but yesterday ended up with a bowl of cheerios. When we looked at the graph later on in the day he laughed at the spike - but it helps me teach him why foods like that are not the best choices for everyday meals for him. There was no immediate action that anyone dealt with at school though. He also uses it before recess or PE at school - to see if he should do a finger stick or not. He basically knows for himself what numbers should be double checked etc. So if he’s 200 before recess or PE he just won’t do anything. If he’s 100 he’ll usually double check since he does tend to go down pretty quickly in sports.
His teachers and his nurse know he has it on, and they’ve seen how it works and what it does, but I don’t expect them (in 5th grade) to do much hands on stuff with him and his management anyway.
I don’t know how helpful that is, but that’s our experience!
Sounds like your son is becoming pretty independent in his management with your help. Is that why you haven’t felt a need to teach the school nurse and teacher more about it? If some of his spikes are prolonged over a couple of hours, though, it might be good for him to have a nurse who he could talk with about that and maybe give a small extra bolus to keep in range. Any information about kids’ experiences with the monitors will be helpful to me, as I hope to be able to advise other school nurses on families’ successes and difficulties using CGM. Thanks for replying!
IMO, I think you need to let them know that it operates about 15 minutes behind his blood sugar - just in case the nurse is more unfamiliar than she has let on. Or have him tell them. There is nothing like a CGM to put everyone at ease. He will thank you someday for having it.
I think the question is, “will there be problems getting CGM once the concensus statement is published?” Time will tell. Remember the insurance companies have lawyers for the purpose of obstruction. Simply obstruction to increase the time before they have to pay.
Hi Bob,
Thanks for taking a project like this on. Our son was diagnosed in Feb of 2010 at 12 years old. He is using a Minimed Reverl with integrated CGM. He is now 13 and in 8th grade. Unfortunately, living in California, we only have a school nurse that visits for 3 hours once a week. Helpful huh? Especially last spring when we were newly diagnosed.
Tanner is very responsible and we are really proud of how hard he has worked to learn how to keep himself healthy. He manages his care at school, with my support via text message and phone calls. His teachers and the school staff are aware and have been taught how to recognize highs and lows and basic emergency care. They have nothing to do with his CGM or diabetes care. Tanner and I handle it all.
I would love to post this to Facebook, as I know a lot of other moms with younger children using CGM’s at school to help manage keep their children safe.
If I can answer any more questions, let me know. Thanks.
April
Thanks for your reply, April. I heard about CA’s miserable school nurse staffing levels while in school last summer. I’m still relatively new to these social networking./chatting sites, so it is taking me awhile to get up to speed, but I would love to have you post it to Facebook if you think that I could gain more insight about kids CGM issues from that. Sounds like you’ve worked out a good system to support Tanner despite a lack of school support. I suspect that parents of kids with CGM will know a lot more about managing the technology for some time. That is why I’m trying to learn what you all find lacking in schools so that I can help teach school nurses to better serve your kids. Feel free to post this to Facebook and please let me know how/where to access the responses. I did get a Facebook account at my son’s urging, but have largely avoided using it as it places such a drain on my time. Thanks again, Bob
I have to post a comment about the CA nurses actions in California. April made a very clear point about how her son successfully manages his D at school. The CA Nurses Association has made it their fixation to keep anyone but nurses bared from helping student in CA schools treat themselves in some cases and in all cases bar anyone other than a nurse or parent from helping with insulin injections and treating lows.
To say that this is unethical is an understatement. The head of the CANA responded to me during their court case to bar non nurses in the school D treatment team, by stating that only nurses are qualified to provide insulin injections in schools and that I am not capable of understanding all of the dangers of using insulin because I am a non-medical professional. Honestly, I know more about T1D and D management than 95% of the medical professional I have met since my diagnosis. I test them before every interaction, treatment, consultation and MD selection.
There is no money for nurses in CA schools and no source for future funding. It certainly appears that the nurses are driven by territorial incentives and not by the critical need to have immediate assistance available in the school for a T1D.
I do hope that the appeal efforts by JDRF and ADA get back the rights for the schools to have non-medical T1D trained persons to help T1Ds manager their D successfully at school.
S Woodward you are right on. I am so grateful that our son is the amazing responsible kid that he is, and that I have the opportunity to be a stay at home mom. For families with young children and parents that have to work this is beyond unethical. How in the world is a 6 year old expected to do this on their own?
As responsible and careful as our son is, we all know that lows happen. I am glad we have another tool with his CGM but they are not perfect. When he is in school I am on-call the entire time. I plan everything around being available in a minutes notice in case something happens. I have no backup at the school. I trained his friends at school as well.
For the CANA to claim that only nurses are qualified to deliver insulin- I say BS. Like you, I have to drill every health care professional I encounter and am continually shocked with how little they know. I am not a Dr., nor trained medical professional, but I play one in real life every single time I adjust a basal rate, treat a low, give extra carbs to cover activity, give a correction to treat a low. Even when we participated in a clinical trial that required admittance to UCSF, the team of Dr.s and endo’s referred to Tanner and I for his diabetes care- why?- because we were the experts. The situation is appalling.
I apologize for the digression. Obviously I feel strongly about the situation.
Hi Bob,
I did post to my news feed and hope to send some traffic your way. I put a link right to this page, so anyone who clicks it can read your post and comment here. Facebook is a whole another world, but I have gotten a lot of information and connections in the Diabetes Online Community.
I can only speak from my own experience with the school nurse (which is almost non-existent). The nurse that I met that comes to our sons school once a week for three hours was a very nice woman. She was familiar with diabetes and checking blood sugars. She understood how to treat low blood sugars and to check for ketones. When Tanner was first diagnosed and was on DMI she was unfamiliar with the different insulins he was on. Now that he has a pump she was very unfamiliar with the pump. I could NOT trust her to operate Tanners pump. She was curious about, but knew very little about a CGM.
I wish I could help more, hopefully some moms with more school nurse experience reply.
If anyone is 200 before anything they should be taking action to lower it ASAP!
My daughter was approved by her Endo for a CGM, but Medicaid doesn’t cover it or the censors. I called ADA and they don’t help with nothing. They are good for asking for money, but not helping those who are low-income in obtaining what they need. I’m really disappointed on that, because it’s not just asking for funds but also helping the people who need it. Florida Medicaid is slow when it comes to whats best for the patients who are diabetics. The CGM’s can be used on type 1 and type 2 diabetics and as far as schools go some don’t even want to touch your child if they need meds or other things that have to deal with any thing medical not even a Tylenol. I’m still waiting for a response from Medtronics to see if they approve my daughters financial assistance application.
That’s a bummer about Medicaid. Check out this link at Juvenile Diabetes Research Foundation for help in trying to get CGM coverage: http://www.jdrf.org/index.cfm?page_id=106514. They also have a survey that you should try to fill out as it helps them in trying to advocate for more insurers - including the government - to begin CGM coverage. You might also apply to Dexcom and Abbott for financial support in getting CGM, though I’m not sure what programs they have. Keep on Fighting for Stephany!
Wow, I sure wish I felt like I was entitled to get them for free too…
yes and I feel I am entitled to tell you that you’re comment is incredibly rude and not welcomed here.
I don’t understand what you are saying what was rude? The truth is the the truth. CGM’s are not free
Maybe I misconstrued her meaning behind the words, but the way her comment is written comes as a personal remark towards you that since you are low income and use medicaid that you feel entitled to get a cgm and sensors for free or cheaper than others with private insurance.
I would be happy for her to clarify otherwise.
I won’t try to defend you again.
You don’t need to defend me I can do it all on my own but thanks . Just because I’m low-income and on Medicaid doesn’t mean I get things for free. I consider that an insulting remark and that’s on called for. My daughter is 13 years old and qualifies for Medicaid due to her diabetes. And the CGM and censors are not free for her they cost me money, that no one but me is gonna pay for. It’s discrimination against low-income and unless you walk in our shoes no one should judge. People have different situations and not everyone is born with a golden plate in their hands.
I’m going to clarify something for you and you can pass it down, private insurances are more lenient in approving CGM’s and censors that Medicaid. The paper work is put thru faster and approvals are quicker than Medicaid. So if there’s a privilege is having private insurance they are dedicated more to the patient than Medicaid.
I really hope you are not directing your commentary at me. But thanks for explaining that to the masses?