HMO may take my CGMS

I received a call today informing me that my HMO (Harvard Pilgrim Health Care) has decided to discontinue coverage of the CGMS. I am so sad. My A1c at the start of my CGMS use was 7.4%. Within 90 days of CGMS use, I dropped to a 6.7%. I am so sad that they will not cover it anymore as I cannot afford to be on it without their assistance. At $30 per sensor I will be paying just under $90 per week to continue using this. I cannot keep the sensor on the 6-7 days that some users are able to due to sensitive skin irritation that I encounter if I push use beyond the 3-day mark. I will have to give this wonderful device up once they discontinue coverage…date TBA. If you have Harvard Pilgrim, please help me to fight this! Call and voice your opinion 1-888-333-4742. They need to understand that they will ultimately pay more money covering our medical bills due to diabetes-related complications (that this wonderful device can surely help to prevent) than they will for paying for this device upfront. I feel defeated; I was so very happy with my health plan and everything Harvard Pilgrim was doing to help me improve my health. Now, I feel that they have given up the fight.

No, actually I loved using them for 6 days. I found my readings were better after the 3 day point passed. However, I have high skin sensitivity to the sensors and basically any adhesive that touches my skin, so I have begun changing my sensors every 3 days to avoid infection/irritation.

Can you appeal through whatever process they have for appeals.

I have Fallon and the nurse there told me they have all kinds of rules and regulations, but if you get your doctor to write a letter, they will ease up on many of the things that sound iron clad.

So find out what their appeals process is and see if you can appeal.

Great news! I have heard that a doctor in Atlanta, GA (David Body) has done some research on the effectiveness of the CGMS pump that has helped convince Harvard Pilgrim Healthcare to cover this system again! I have not tracked down any proof of this online yet, but the news is so promising!!!