Dept. of Veterans Affairs Support for CGMS

Has anyone had any favorable experiences in obtaining support for CGMS by the US Department of Veterans Affairs? I do not have health insurance, so I rely upon the VA for treatment of my Type I IDDM. Back when I did have insurance, I used the 1st generation Dexcom, and was quite pleased with how it helped me to manage this frustrating disease. When the System 7 came out, I had lost my insurance and was not in a position to upgrade. I’ve had Type i for 14 years, which has led to hypoglycemic unawareness. Last month I ended up in the hospital with a BG of 20, so you can imagine how eager I am to again start using this tool.

I’m very pleased with the physicians I’ve worked with at the VA, but the bureaucracy is beyond maddening. Any anecdotal information or suggestions for gettng back on CGMS through the VA will be HUGELY appreciated.

Hi Tom. Just joined here and wanted to tell you that I am also a Vietnam Vet and have been receiving all my care from the VA since 2000. They have treated me most excellent. They put me on an insulin pump in 2005 at Hines VA near Chicago. Excellent VA hospital and Drs. I am now at the Kansas City,MO. VA and they seem even better and more up to date with their diabetic program. They just gave me a new MM722 + CGMS. I am most thankful too. I really have nothing to complain about. They treat we just great. I realize we all have different experiences with the VA, but mine has been 100% great.
Wondering how these last 3 months have been for you?
Best wishes,
Ron

Dear Ron,
My experience has been pretty good lately. In CT the doctors were all either intructors or students from Yale Medical School, and after moving to NC a year ago the same holds true (but Duke Medical School this time). Prior to that I was treated at both Broklyn and the Bronx - quite nightmarish.

I just had a PCP appt today, and talked her into signing off on a Dexcom prescription, though I’ll have to pay for it with Master Card. A couple of weeks ago I broached that with my Endocrinologist, and although she was all for it, she told me that VA doesn’t support Dexcom. Before I eat that $1,000+ soup sandwich, can I ask how you got yours?

In an even happier development, I reopened my claim last year (was 20% for diabetes) and got the combined rating raised to 100%. What a huge difference that will make. I am still stunned at the favorable result. That said, I did TONS of research prior to the re-filing, but it looks like it paid off.

I must confess that for as frustrating as the bureaucracy can be at times, it is a blessing to have access to that care. I’ve been singing their praises for the most part.

Thanks for your service during a horribly challenging and difficult time. I am old enough to remember my friends who had fathers and brothers over there. I know that I was sheltered from much of the ugliness, but I was always in awe of these guys. My Dad was an old WWII guy, and he instilled in me that no matter what, it was the highest possible calling to serve. He was right. One of the most precious memories I have is when I took him to DC for the dedication of the WWII memorial. We were in the Crystal City Metro station waiting on a train and a lady walked up and asked him if he’d served in the war. He said yes, and she asked him what he’d done. He told her he was a navigator on a B-24 bomber in the 8th Air Force and flew 14 missions from England. She said “Thank you, sir for what you did” and asked for his autograph. He was speechless, and it was the first time I’d ever seen him get teary eyed. To this day I get choked up. He said that he’d only been asked twice about what he did, I got to see it once. I hope that something like that has happened to you. If not, please accept my appreciation and gratitude.

Thanks for the reply Tom, and thank you for your kind words. So good to hear of your results. I got my first Medtronic pump(MM715) from Hines VA , in the Chicago area. My endo was from Loyola. Got that pump in Dec. 2005.
Just moved here to Kansas City,Mo. in June and this VA is as good or better with their diabetic program. Just 2 weeks ago they gave me a new pump(MM722) and the CGMS. So now I have a quick-set for my infusion and a sensor site as well. Tom, they GAVE me all of this. I pay nothing. I didn’t start using the VA until June 2000. I get all my meds, test strips, insulin, infusion sets, and CGMS sensors free. Medtronic has 2 reps. that I have met 2-3 times now. They come to our VA hospital to work with the diabetic nurses. It was 1 of the Medtronic reps. that trained me on my CGMS here at the VA hospital.
I am wondering why you will have to pay for a pump. I am only aware of the 2 VA hospitals I have mentioned, and both ONLY use Medtronic pumps. Could this be a reason you would have to pay for the Dexcom? Does your VA give any of their patients insulin pumps at all?

Congratulations again on getting 100%.
Ron

Getting pumps are not a problem. I got mine when I was using private insurance. I sent the order to Dexcom on Wednesday afternoon and had received it and “installed” it 18 hours later. I previously had the 1st generation Dex, and paid $250 for it (long before insurance companies ever knew what it was). The Seven+ is a serious improvement and well worth what I paid for it.

Our prosthetics folks in Durham are awesome. At my first Endo appt., I told the Dr. that I needed pump supplies. Four days later UPS arrived with a year’s supply of infusion sets and reservoirs. Then I needed a blood pressure monitor. I went to their office with the request and they handed it to me on the spot. Later a podiatry nurse saw how fouled up my feet were and put in a request for orthopedic shoes. I went up to see the prosthetic folks and they handed me a voucher and list of vendors, and within a week my feet were comfy and pain free. The pharmacy is equally outstanding. When I put in a refill request online for insulin, I usually have some nicely chilled vials within 72 hours.

I am wondering if the VA considers your Minimed CGMS as a component of the pump?

Thanks again for your reply Tom. Would your VA have given you “any” pump at all? I’m not usre how my VA looks at the CGMS, whether they consider it a component of the pump or not. When I newly arrived a couple months ago there, they told me they were using CGMS for any of their pump patients who needed it. They thought that I needed it, so they upgraded my existing 4yr old MM715 to the MM722 and shipped to me all the CGMS supplies as well.
I have read many complaints about MM CGMS, but I sure haven’t had any of them. My readings for the most part are extremely good. I too have hypo unawareness and the alarm features have really saved my butt more than once.
They only “complaint” I have had is that this VA does not provide the test strips that I use with the Paradigm glucose machine.(that transmit wirelessly to the pump). My VA in Hines,IL. sure did.

It is a shame that you had to pay for your pump and I assume pay for the pump supplies too. I guess the VA only uses MM as formulary.

I need help from both of you. If you need to respond through private message it is ok.
How did you get your combined up to 100%. I have been to prosthetics and have been issued shoes. The other day I went in and asked for a pump and they switched me from syringes to a pen (I am thinking big deal). I am very grateful but I literally had my @ss chewed up one side and down the other by nurse practitioner Moriarty. I know my blood sugars have been out of control but that is why I asked for a pump. I, like both of you, do lots of research before my visits and I was treated like a damn 3 year old, much less a veteran or an employee of the Veterans Health Administration (of which I am both). I have a policy letter dated 2009 that states the requirements for prescribing a pump (minimed will do fine, the VA has a medline contract for many things). Is there a newer policy or guidelines for prescribing a pump?
In your increase to 100% combined, what new things did you add to your claim? I am a syndrome X, and I was diagnosed 4 months after I got out of service.
I hope I don’t seem like I am lashing out at you two, I am just so frustrated. Please help!

Marty,

Well Well Hmmmm I can’t type worth ■■■■!!! And grammar ok… So bare with me on this…

After 18+ months (this is after my 2 adult sons told me to get on PUMP THERAPY CSII) I contacted or made an appointment with my Primary Care in Nov 2009 she and 5 others have managed my diabetes’s for the last 4-5 years or actually my whole tenure on being a type one for 24 years… as you I waited and almost died LITERALLY cause I had the Ole Marine Corps Attitude not to go to a doc for 5 months and end up in kidney/liver problems including a plethora of other aliments including becoming a TYPE I diabetic…

Mine 100% I would have to write huge 7-8 paragraphs on what mine entail!! My combined is 165% but only received 90% don’t understand the VA MATH but I didn’t get my 100% till applied for unemployablity to then rate that was a pain for a years but my primary point blank said and then the 18 jobs I had in the last 15 years help also and in my 25 years 24 jobs total!!!

The pump and CGMS I am now in Medtronic Paradigm Revel 723 pump and as I said took me 18+ months to get and that took a letter from a US Congressman Keith Ellison but, that still hasnt gotten me the CGMS yet, I did finally meet with the ALLEGED HEAD of ENDOCRINOLOGY Dr Georgeopolis in Metabolic Unit at Minneapolis VA Medical Center (I have been working with a DCM (Diabetic Case Manger) also for the last now 14 months… but a month and 1/2 ago. I was sooo Efffn pissed off I could Spit… I told the Doc George… I want PUMP and CGMS (I also suffer from HYPO UNAWARENESS) I got every excuse (other that pump was ok’d) but she want me on CSII for at least 6 months to get use of PUMP and then SHE MIGHT JUST MIGHT Consider it!! she told and my DCM only one Vet at Mpls had a CGMS that was Pregnant Women Vet…) So again I got ■■■■ again , really pissed and told her why is her life/care different than mine (the Baby isn’t in danger but mother is and Just as I am in danger from lows and liver/kidney issues!!! She said it expensive and CGMS hasn’t been proven to be a valuable tool yet to aid in CSII and diabetes care QUOTE!!! I told her ■■■■■■■■ (referring to New England Journal of Med/Harvard Joslins Diabetes Medical + ADA and JDSA and TUDiabetes formats!!!)and of course my sons got [pissed at me for being an ■■■■■■■!!! to her!!! But after all the research I have done I find it ■■■■■■■■!!!

So I have been on PUMP THERAPY for 2 weeks on Monday going ok… my mg/dL are super high and getting use to… I am still fighting for CGMS system yet and I printed off all the fact from this sight and other who use to aid in my fight to obtain the CGMS with CSII…But, I agree it’s a Efffn pain in the ■■■ here at VA in Mpls, Minnesota… They are Frugal/Cheap asses period!!!

I gotta run …Going Skiin up north for finally weekend or Sunday they are opening in the Arrow Head area at Lutsen/Eagle Mountain for Skiing!!! Gotta et up at 3 am to get up there in time!!! 4.5 hr trip 250 miles!! if you need more info call me 612.321.6887 or email deansemperfi@yahoo.com

I hope this starts to help in your quest!!! and I will help anyone period who the VA is messing with just for the right tools to manage our TYPE I Diabetes!! Period!!!

Semperfi

Dean (aka: Dino)

I am still running into a wall. I have contacted my congressman’s office and seeing what they can get done. I am miffed and don’t really know what to do next.

Hope I can provide some insight or help to you guys. First off thank you for your service to our Country! I am a VA employee in fiscal service and am glad that you are having mostly positive experiences and treatments with the VA. One of my responsibilities in Fiscal service is to make sure the invoices we receive are accurate. Therefore, I can tell you that my VA hospital does receive invoices from medtronic (pump and CGM). I have not seen any invoices for Dexcom and I doubt that my VA hospital uses them, but other VAs may. Of course I do not have clearance to look at medical files or anything like that.

The general process (as I understand it) to get a pump or CGM would be something like this: A prime care/internal medicine/endocrinologist physician has to recomend that a CGM would help you. Tell them everything that is true that will help you get a CGM (hypo unaware, difficult to control BG, etc.). This physcian is the one you must convince that you need a CGM and I would bet you would have more luck with a specialist like an endocrinologist that is more familiar with CGMs. If they agree that the CGM would be benificial they will send you to prosthetics to get (or be sent) the CGM.

I do not get too involved in the clinical side of the VA so I hope this helps some.

I agree - You should already be seeing your Endocrinologist anyway as a diabetic.

In all my cases, my Diabetic Training Nurse who works closely with the Endos was the person who gave me my Medtronic CGMS. I have been on a Medtronic pump since late 2005, and it was given to me by the Hines VA(Chicago).

I was given the CGMS by the Kansas City,MO. VA in 2009. I didn’t ask for it - they just told me I would be using it. Of course I was elated.



My experiences are in direct opposition to what Mary seems to be encountering and I just don’t know why.

I have been Type 1 for 28 years - verified by the VA too. I do not know what Marty is, so perhaps this might have something to do with his difference.

Many Vets here are using the Medtronic CGMS. I do not know of a VA hospital using anything BUT Medtronic.

I have met with the local Medtronic representatives here while at the VA for appointments.



Good luck Marty and keep us apprised of how things go for you.

I am a type 1. I was diagnosed when I was 31, had it 7 years so far. I was told by my Endo APN that I could take my federal blue cross insurance to a private practice and get one now but at the VA I would have to see. I am service connected, have low episodes, my A1c is 9. I take multi injections and now my kidney filtration is declining. Do I have to lose a kidney or a foot first?

Makes NO sense at all. I am at a loss as to why you are having problems. First, to use CGMS, you need to be using the Medtronic insulin pump. Why are you not on an insulin pump?
That comes first before the CGMS is added as an extra feature.

I qualify under secondary standards set forth by national VA policy for receiving a pump and cgms. One person was issued a pump in Little Rock but…well I have no idea. My APN says they don’t use that policy but, when I asked for a copy of the one they used, I was told it could not be found.

Hines VA located in the Chicago area has been giving Medtronic insulin pumps since late 2005.
Kansas City,MO. VA gives the same pumps to many diabetics.

Why your VA does not give insulin pumps to type 1 diabetics seems very weird. Something is not adding up.
I would be contacting either my state representative and/or contacting your local VA representative such as VFW-DAV-American Legion. They are great at helping cut thru the BS like what you are encountering now.

Tom,

I'm a service-connected T1DM (33+ years -- see my profile page). I receive all of my medical care at the San Francisco VAMC. In 2009, May, the Prosthetics department there got me a DexCom System Seven Plus, but it took about six months to get the paperwork approved (somebody in DC had to sign off on it, I believe). Since then, the pharmacy has filled the sensor Rx with no problems, as well as a new transmitter Rx once a year (just received a new one today). The Diabetic Educator NP was the one who put the bug in my ear, and in the Endocrinologist's. (The doc was, and continues to be, tremendously enthusiastic about me using the CGM, and overall, his enthusiasm has been well justified.) They (the SF VA) do also supply Medtronics insulin pumps, but I've been an MDI guy since before there were pumps, so I still use needles.

In the time since I kinda broke ground, they've applied (...so I'm told...) for some other patients to receive DexComs and been denied. One fellow (...so I'm told...) bought his own starter kit (...$1,500+...so I'm told...ouch!), and once he had it, the pharmacy had no trouble filling his sensor Rx. Seems (as alluded to in some other replies in this thread) that getting stuff through Prosthetics and through the pharmacy are two very different ball games. In any event, my experience says that if the MD can justify the acquisition, then its just a matter of red-tape time lags.

I hope this is helpful!

Best regards,
--James =^• •^=

It makes me happy to hear that you all are squared away. I wish the Docs at Chicago,KC, and ST would all call my Endorsing doc in Little Rock and explain the almost effortless improvements in quality of life and disease treatment that pumps with CGMS provide. I contacted the Wounded Warrior Project yesterday and they responded with “one way or another” they are going to make this happen. I work at the VA in surgery but am on the verge of losing my job because of days missed with hypergly mornings.
I greatly appreciate the stories. Every one takes a brick out of this wall I am facing. My APN has tried to tell me how complicated this system is. I respond that these systems are given kids for disease management. Am I off base?

Marty,
I don’t know if you ever got anywhere with the VA, but I finally got one in Augusta, GA though I am the 1st one to get one. They(Medtronic) told me the Decatur (Atlanta) gives about 25 a month to Vets. I know that doesn’t help in your location, but says the VA does use them. I wrote every State Rep, Congressman and even the President. They were all quick to respond, with the exception of Obama, but never expected to hear a thing from him. Don’t give up and keep trying. Rattle as many feathers as you can. It seems the squeaky wheel gets the grease. I’ve heard Doctors say they can’t do anything, the Vet has to say something to get anything done. Have you talked to your local DAV office? Also try your local Dept of Veterans Affairs office, they were good in following up with me. As a matter of fact. I had an email the next day after my emails to congress and a call that afternoon saying the pump was ordered and on the way, though it did take a few months after that. They called on 4/11 and I got my pump started on 7/21.
The pumps can look complicated at 1st, but it really is quite simple. Just make sure you have a good grasp on your carb to insulin ratios and good carb counting skills. I have not read it yet, but many have recommended a book called “Pumping Insulin” Take a look at it on Amazon. I could not find it locally. If you have any questions or I can point you in the right direction, let me know!

That is GREAT information. I really appreciate it. I have contacted the Wounded Warrior Project as well. I agree with the squeaky wheel… I will check out that book too. Thanks!

No problem man. My pleasure. I got a lot of help from the forums, now it’s my turn to pay it forward. If ya want to see the letter I sent, send me a PM and i will show it to you.