Is there anyone here that Medicare has covered your CGM?
I have been in touch by email with a wife of a type 1 who is on Medicare and has been denied the Dexcom CGM which he was on before Medicare. They had a phone hearing with an administrative law judge, and are waiting for the decision. Have you started the appeal process yet?
Best wishes and good luck.
Al I ever got was no and good luck!
Please let us know how it goes. I'm looking at the same situation in 5 years. Can't believe they would rather have us end up in the emergency room when a CGM can be so helpful in preventing the lows. I wear mine 24/7 and would hate to ever give it up. It is a lifesaver!
I have not started the appeal process yet. I was wanting to see if there was anyone that was successful and might be able to help me in my quest. Appreciate any help or suggestions.
Google it. I came across an article explaining how to have CGM through medicare. It's possible although your medical condition has to justify it.
Here's some info on hypoglycemia unawareness from the Mayo Clinic web site:
Living with diabetes blog
Aug. 10, 2011
Understanding hypoglycemia unawareness
By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.A patient shared the following story:
She was in a grocery store and felt that something was wrong, so she walked over to the checkout lane and grabbed a couple candy bars off the shelf. She stood there in a daze, clutching the candy bars in her hands but not eating them. She must have looked like she needed help, because a woman walked over to her and asked if she had diabetes. The woman told her to open the candy bar wrapper and eat the candy right away. My patient was in such a confused state that she hadn't thought to do that herself. The woman stayed with her until she felt better and told her that she had a family member with diabetes, who she'd assisted before when he or she was in a similar confused state of low blood glucose (hypoglycemia). My patient was lucky to have received this assistance and avoided the need for an emergency medical response team (911) call for the seizures or unconsciousness that could have occurred with severe hypoglycemia.
If you've had diabetes for any length of time, especially if you've used insulin, hypo-unawareness is a persuasive tack to take as is shown in the above example, it can save them (Medicare) serious money. Hypoglycemia unawareness is also know as Hypoglycemia Associated Autonomic Failure (HAAF). Autonomic neuropathy is common in long term diabetes, also affecting digestion and motility of the entire digestive track. It also can raise the heart rate.
Medicare must understand that one ER visit wipes out the false savings from CGM coverage denial.
In addition to this posting, I would call Dexcom, or Medtronic, if you are selecting them, and ask them if they know the best way to get it approved. When I switched from Navigator to Dexcom, Dexcom knew that my insurance company now covered the CGM, and knew exactly what the insurance company required.
Reposting here a message that came out locally in an insulin pump support group of which I am a member. The blog link at the end may be of interest to many.
Hi:
To those who are unaware of Marc’s diabetes and our fight for Medicare to cover a Continuous Glucose Monitor, please read the blog that I wrote and pass the link to the blog on to everyone on your e-mail list. We need to get Medicare to change the guideline for coverage of this device and the sensors needed to monitor glucose levels for people like Marc who have brittle diabetes with hypoglycemia and hyperglycemia unawareness. This device is a matter of life or death and I’m trying to get the word out to as many people with diabetes as possible in order to change the guideline. The more people we find who have this condition, the faster we might be able to get Medicare to pay for this expensive, but lifesaving device.
Sue
http://testguessandgo.com/2013/07/25/a-crusader-for-medicare-covera...
This is an excellent issue. I had serious problems with my type 2 and nasty liver dumps that ended up shooting my BG all over the place.
After getting on cgms and watching/monitoring all the time was with Doctor's help got the mess and issues under control.
There is this idiotic hare brained thinking that the body and its blood glucose are not fast moving, not moving dynamically and one can take one's sweet time/monitoring, correcting and managing that diabetes.
As Sue indicates and my own experiences have demonstrated, nothing could be further from the truth. Where this stone henge witless thinking comes from is utter breathtaking in a day of science and trips to moon in 1970's
Yet when one looks at medicare caveman strip testing allowances one sees a similar type of retrograde thinking.
the ability to have advanced testing tools does and Sue indicates gives onea whole new avenue to manage nasty fast moving (Brittle) diabetes and nasty liver dumps. I finally gave up on 30 strips a day and moved over to cgms.
I find myself appalled at this dark ages mentality towards diabetes type 1 and type 2.
one of the problems here is that CGMS need a prescription to get one - what in hades for - you cannot dose with it for insulin shots. instead of making this device under volume manufacturing techniques and get all the paperwork/fda/idiocy out of loop and get device down to $ 200 and sensor prices to match, everyone would be better served.
The present mentality is making an expensive, overly managed and restricted high cost product that no one will barely cover under insurance. That serves so few badly.
best wishes and good luck in your questions and comments and thank you for pursuing this.
Federal External Review Process for Health Insurance Coverage.
http://www.cms.gov/CCIIO/Programs-and-Initiatives/Consumer-Support-and-Information/csg-ext-appeals-facts.html
this is a program that you can use after all the appeals have failed for your insurance. I have no experience with this for Medicare.
H.R. 3710 which would direct Medicare to cover CGM is in the beginning process. We should all contact our representatives and senators. As someone said below, the pennywise and pound foolishness of not funding a device that can avoid very expensive ER etc treatments...
Sometimes you have to work with insurance plans for a long time to force it through. Claim 'medical necessity,' that will help. I know a nurse who said it took him forever to get his covered, but he has it now. You would think nurses have better insurance plans.
Same from my Dexcom rep and his assistant.
Although I am not eligible for Medicare, their covering CGM would benefit me because once Medicare says "yes" privave insurance companies follow. We all need it.
I am trying to get data to show how pennywise and pound foolish it is to not coverage CGM (and pumps) and yet cover the costs of the complications. I want to show a comparison of the upfront CGM costs and the longterm dialysis, and other medical costs of not having the info that CGM provides., And there is the cost to society of people with diabetic complications and they support they would need - and the fact that many would lose their jobs, go on disability and lets even include someone like me - I couldn't shop! And I support the economy in a real retail way.
And more and more people are getting top live long lives with type 1 (and type 2) diabetes by taking good care of themselves. To "reward" them with losing their CGM coverage is just plain stupid - and mean. More and more adults are being Dx'd with rapid onset type 1,a s well as LADA.
Sometimes I think that there isn't wide spread coverage because few people have the same insurance company for a long time, and any complications from not having the tools we need will be another insurer's problem.
It looks like Medica in MN will cover, under certain conditions. I know thats not quite the same.
Sue finally got a ruling from Medicare & it was not favorable.
http://testguessandgo.com/2014/03/10/unfavorable/
I guess that the hospitals need our money. They have more political muscle than do Dexcom & Medtronics.
Kristi,
Before going on Medicare, my Health Insurance Company covered my CGM. Medicare is different. The companies that manufacture the CGMs know this. They have been trying to get Medicare coverage for years. They have results from numerous studies showing that CGMs are essential. The accountants at Medicare (doctors don't make the decision) don't care.
I have been forced to pay out of pocket to the tune of $4200 a year. It's a large expenditure, but I credit the CGM with saving my life on more than one occasion.
I'm sure, that if Medicare were to cover CGMs and sensors, they would be able to negotiate a much lower price than what I am currently paying (The price Medicare pays for 100 One Touch Test Strips is somewhere in the vicinity of $21. They pay $1.50 for a hundred lancets).
In the current political climate, where all government programs are being cut back, I don't see anything happening.
The bill H.R.3710 was introduced to congress Dec. of 2013. Here is a site with the information. Everyone should send an email/letter to their Congress person asking to support this. Give them examples of how this keeps you healthy and out of emergency rooms and hospitals.
http://beta.congress.gov/bill/113th-congress/house-bill/3710
I wanted to share a youtube video I recently heard and about and wawatched. It is an interview with Dr Eric Topol by Dr Nancy SNyderman. The subject is "iDoctor" and addresses wireless medicine. One of the key points is the incredible aMOUTNS OF $$$$ spent on tests, labs etc. and how cardiology and diabetes can benefit from devices like CGM! He talks about the money spent on tests and how much faster and better communicating via these devices can work. I don't know how to contact Sue in her fight, but maybe watching this video and then contacting Dr Topol might help. He is currently at the Scripps Institute - a fabulous medical center.