Some of you may remember my post where my endo has been pressing me to make sure I’m not having lows overnight. And I’ve struggled with my feelings about her coding me diagnostically as type 1. Up until now it hasn’t made a difference in my treatment, but I have agreed to get a Dexcom. I ordered it a week ago and just got an email that it shipped. It was just approved, no letter of medical necessity, no appeal. Just approved. I’m not all that clear that I would have such speedy approval and zero pushback if my endo had coded me as type 2. So I guess this is that first step. The first time my doctor has coded me as type 1 and it made a difference in my access to treatment. I feel lucky that my doctor will work with me to get me the best treatment, but I also feel kinda sad that there is such disparity in access to treatment.
ps. I also kinda feel rushed. I didn’t actually expect it so fast. I’m not sure I’m mentally prepared for this. I may let the box sit on the kitchen table a while before doing anything.
I know you’re still feeling “iffy” about your diagnosis as Type 1 vs. Type 2. If part of your reluctance in using the Dexcom is that you got it unfairly, though, it does seem that more insurances are covering it for T2s as well. I have BCBS and it’s covered under my pharmacy benefits - no questions asked. Just not DME. Which is actually fine, it comes out cheaper under pharmacy benefits, I think, anyway.
If you’re just feeling rushed, it’s OK to let it sit for a few days. It is a big step, but it’s a wonderful, wonderful tool once you learn to make the most use of it.
Me, too, I waited several days to “install” the Dex after I got it. I felt like going bionic was such a huge step. LOL, I must have read all the directions 10 times and the first insertion took about half an hour 'cos I just stared at the inserter stuck on my belly contemplating how much it was gonna hurt…and then it didn’t!
Congrats on the approval! I’m happy for you! Depending on your insurance, they may have approved it either way. I didn’t fall into my insurance company’s standards for ‘severe hypoglycemia ( <50 )’ because I know I am hypo-unaware and check 12 times a day, and I’m 99% sure my husband feels my hypos for me (he’s only missed one, which is when I hit my one under 50, on NPH and R in the good old days I would commonly hit 29 or so). My endo fought for me because I do not have a predictable schedule, drive 40 mins either way to campus, and can teach classes lasting from 50 minutes to 3 hours. I think that’s the only reason I got it.
I have always resisted the t1/t2/t1.5 because I feel as though having the separate categories limits how we treat high blood sugar. I was originally diagnosed as t1 in 1999, changed to t2 in 2002 (because the wrong tests were ordered during my honeymoon period, I think) and now have been diagnosed with LADA. I wish we could just call it Diabetes and get all of the tools we need to be healthy, rather than being called non-compliant because the ‘gold-standard’ for the type isn’t working (can you tell I get bitter?). The disparities in healthcare are terrible in so many ways. I think that’s why I ended up a Sociologist rather than an MD.
I would totally let the box hang out on the kitchen table for awhile. I’m a gadget person, so I did start it up right away (I have been reading and watching videos on the Dex for a bit over a month) but I did that with my tSlim. I shoved it in the corner until 12 hours before my training appointment.
I’m happy that your insurance didn’t give you the run around. I’m glad your Dr. is doing what she needs to to get you the tools you need for your Diabetes Type Brian!
Also, make sure to check the SN on the bottom of the transmitter with the one on the box when you do get around to setting it up. Not doing that ruined an entire Wednesday night for me.
Brian, glad to read that you have the Dex now. It’s been a big deal for me and I hope you find it just as useful. It provides an education like not other as to food, exercise, and blood glucose levels.
I agree with the other comments about insurance coding and gaining access to needed treatments. Those codes are primarily in place to serve the needs of other parties. It’s a crazy system we live under and I think it’s the job of the PWD to get the best tools and treatments even if it means gaming the system.
Congrats on getting the Dx that gets you the treatment you need. We’re stuck in a system that uses too-broad categories for diagnosis, such that insurance coverage can be denied for treating that people need. Great job to your endo who is willing to work with the system.
… I write this with the July 1 “formulary change” date looming in my near future – my Dexcom script as well as my pump script all expire in early July, and my Apidra script is not far behind that – due to the problems they gave me last year! I never discovered why all the denials I received last year got suddenly reversed, but do not look forward to what may become an annual battle with UHC.
Access to treatment needs to be fixed across the board. Our system that lets insurers, rather than physicians dictate treatment is simply unacceptable and must be changed.
Brian, even you have to admit that a doctor came through for you at least this one time in your life. And all you can do is feel guilty about it?!? You are more of a Yid than even I expected! (Said fondly from one Yid to another. )
I went thru 4 sensors in three days last week, due to adhesive problems and hot weather! I love my Dexcom, but there are times when we have “family spats!”
You may even be able to check through your BCBS website where you check your pharmacy coverage for other things. I was able to look it up there just like any other medication. It’s pretty darn nifty! The Receiver, Transmitter, and box of sensors each have a separate co-pay. The G4 system, the Transmitter’s good for a year, so really the only monthly co-pay I have is the sensors.
Oh, and I totally endorse the previous comments about the inanity concerning types, insurance coding, and access to care. On second thought, “inane” is much too weak (and nice) a word . . .
My current doctor is very patient centered and really works with me. And she has come through for me more than once. But she is not perfect. At least she isn’t like “He Who Shall Not Be Named.”
Youch! Sorry you had such a rough start with the Dex. My second one hit a capillary–blood everywhere, pbbbth!! I really like the Op-Site over the Dex adhesive and use Skin Prep, too, and Uni-solve to peel it off when I change a sensor. Hope that helps!
Interesting. In my time with insulin (admittedly only about 3 or 4 years so far), I’ve never had a “gusher”. But then I’m very old school (syringes and vials), which I suppose lowers the likelihood.
️:wink:
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