I am a type 1.5 with Blue cross blue shield. I have fainted in airports, once while driving a car. I now use a Dexcom 7+. My ha1c has dropped from 7.6 to 6.2 and while I have occassional sub 60 readings, I have never passed out. I had major fights with my insurance but won on appeal. I hear medicare is impossible. Your research could be very helpful. We need to prevent the consequences of high and low blood sugars, not treat the consequences.
Well, the paper certainly DIDN'T say that ALL persons with diabetes were eligible; in fact it very specifically restricted its patient selection guidelines to Type 1. Please get your information correct before you post.
I would appreciate it if you and other Type 1's would be specific when you are talking about your type of diabetes -- you are right when you say there are differences between Type 1 and Type 2, and not all subjects apply to both. This subject in particular does not apply to both!
My doc has me down as Type 1, but in fact I'm somewhere in between, so I call myself Type Weird. What it means is that I read extensively about both types, and am always interested in what everyone has to say, and I appreciate everyone's story. THIS story happens to be a Type 1 story.
Thanks for the post, Dan and congratulations on getting your Dexcom approved! You should feel good about yourself also because your fight may make it easier for those who follow you to obtain coverage - especially as the insurance companies experience fewer ER bills!
Reread the statement and my own and you will see that there are no misrepresentations. I did not state that all persons were elligible. That, unfortunately depends upon one’s insurance company. The AACE states that any patient who could benefit from the continuous feedback of glucose readings and/or the hyper and hypoglycemia alarms are potentially good candidates for this technology. Those with type 1 diabetes have had to fight for coverage right down the line with insurance companies. Those with other types of diabetes may have to do the same, unfortunately. I suggest that you look into how you can be supportive of others on this site who are trying to improve the lot of all of us with diabetes. If you look around you will certainly find MDs who will help those with “type weird” diabetes to fight for coverage for CGM.
I responded to THIS statement you made in your original quote: “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.” Whereas the paper said no such thing – it was very specific about it being for Type 1. Insulin-dependent Type 2 and other types were not mentioned at all.
Being a candidate, or being “eligible” has nothing to do with insurance companies. It has to do with whether a person could benefit from a certain treatment. Thus, insulin-resistant Type 1’s are certainly eligible for treatment with Metformin (in addition to insulin) in spite of the fact that many docs refuse to prescribe it.
And I HAVE a CGM, but only because my doc has me down as a
Type 1.
My husband is a full time, active and valuable employee with GM 10 years from retirement and we were forced to go with BCBS (no choice) Jan. 1st. We pay out the nose for it, have a huge copay and are basically on Medicare. BCBS follows the same guidelines so neither my Omnipod nor CGM are covered. Talk about pissed!
Please, please, tell me what steps you took to win your appeal!!!
Winning appeal. Insurance carries often have guidelines for approval of cgm. This is the first start. Your cgm provider should be able to get these, and you can also contact athe patient advocate office for your insurance company. Low below 50 and high above 225 should be documented and given to your Dr. I had 4 within 6 months between 40-49. Lows may be more persuasive since they can lead to more immediate consequences. For those with adult onset and insulin dependent, there is a blood test that confirms the pancreas does not produce insulin. The history of treating very low blood sugars is also important. Any history in public places of needing others to provide assistance. Any emergency room trips or calling ambulance.
Insurance carriers may have different policies concerning cgm manufacturers. You need to know. Medicare and Medicaid at least for type 1.5 will not pay for cgm but do pay for consequences. A computer is helpful in identifying abnormal highs or lows.
Dont tell me about golden plates - I pay taxes so that you may have medicaid - I have insurance but still have medical expenses of around 15000 per year - I am retired and worked all my life. So I should pay for my own sensors out of pocket and pay taxes for yours too? I worked hard for 40 years and saved a little bit to pay for retirement I am not born with a golden plate nor are most working folks. I also resent the thought that poor are entitled to benefits like the rest of society owes you a living. This whole entitlement thing is ruining our country.
You are correct to suggest that t1d is the group for whom they currently recommend CGM and that is because the research with CGM to date has been performed almost entirely among t1d patients. The text of the AACE statement notes, however, that MDs currently use professional CGM in patients with t2d, as I stated, “who are not at their hba1c target, who have recurrent hypoglycemia or hyperglycemia unawareness or who are pregnant.” It also refers to other studies that have shown benefits for its use among pregnant women with t2d and gestational diabetes.
From other readings of the diabetes research literature, I have found that only about 1/3 of all persons with diabetes are able to achieve target a1c levels. One major reason for this is that as normoglycemia is approached the risks for hypoglycemia rise - a condition which patients, their families and providers all wish to avoid. CGM by providing trend information allows all patients to avoid severe hypo and hyperglycemia and yes, this means that they can benefit from this type of treatment which you state is your standard for whether they could be considered a candidate.
As for the AACE, under the Patient Selection heading in their statement, the group begins with the caveat, “not enough direct evidence is available to propose a specific algorithm to identify patients likely to experience the best outcomes with CGM.” They go on to state that it is the responsibility of health care professionals to decide whether or not their patients are good candidates for CGM. I maintain that all individual with diabetes - type 1 or 2 - can more safely achieve target a1c levels and hence would potentially benefit from CGM use. This is not a “type 1 story,” but part of an outline for achieving what can be: better glucose control for all persons with diabetes.
I would feel the same as you do in this circumstance. Have you tried appealing the decision of BCBS? I don’t know about the pump process, because I do MDI, but many BCBS plans cover CGM and an increasing number do so as time passes. However, many current users have had to make multiple appeals and present considerable evidence from medical records before the insurance company finally agreed to cover the expense. I’d recommend going to the following link for starters, if you have not yet tried this. I have a BCBS plan in MA and my dexcom is covered fully with copay of only $25 for 4 sensors.
http://www.jdrf.org/index.cfm?fuseaction=home.viewPage&page_id=46DCC616-1321-C834-037283D0E1786661
Thanks Dan! Crappy BCBS, husband is still employed with GM but we are basically on medicare. Just went in for blood work for another pump. Documenting lows and highs is no problem, just had a 47 this morning. About to go download Dex and pod info so we’ll see. I am going to call Dexcom tomorrow and see if they’ll help at all.