I am going to call the GPs office tomorrow morning and perhaps I will get a different nurse who has more compassion than the one I spoke with today. The weather is forecasting blizzard like conditions, so may have to wait until early next week for an appointment if one is available.
Next week I see my Podiatrist who works in a clinic. I think there is an Endo who also has an office in the same clinic. I will ask the Podiatrist if that Endo is still on staff there and if she is seeing new patients. I live in a relatively small town and there aren't that many Endos who practice here.
I'll go do work out in their lobby for a few hours and see how many test strips they ought to give me. Or offer to drive them to lunch after 1000 jumping jacks "are you sure you don't want to give me ONE MORE STRIP YOUR HIGHNESS?"
yes! but the patient, mayumi, has to provide the info to the doctor to fill out the medical necessity paperwork, they need logs, downloads, etc..showing why the patient needs more strips, etc..this nurse has no say in it.
I just went through this with my Endo and Medtronic..my endo had to send them my latest CGM trial report and 30 day meter report(s) - numbers, showing (ironically) that I test MORE then 4 times a day for my insurance company to approve my pump, test strips, supplies, etc..it isn't medicare or medicaid but it's the same idea and practice.
If your insurance will cover a CGM, then consider yourself fortunate. Medicare doesn't recognize the medical necessity of a CGM system and therefore will not pay for it even partially. And my secondary insurance will not pay anything at all on a CGM IF Medicare doesn't cover. Either way I'm out of luck. So I pay out of pocket for my CGM.
This nurse led me to believe that she is the one who has to fill out the forms so perhaps I have to cooperate with her.
mayumi, i had a stupid nurse a while back tell me i should only be testing 4 x's per day; before breakfast, before lunch, before dinner and bed. I said, literally to her, "I have a Rx from my Endo, the person whom you work FOR, to test 10 - 12x's a day..why the heck would a type 1 insulin dependent diabetic test before a meal and not afterwards? I test before I work out, afterwards, after meals, high - lows - corrections, before I drive..I'll test as many times as I d@mn well please, thank you very much and you, frankly don't know what you're talking about." That shut her up..she doesn't work there anymore either...!
just make an appointment. you've been doing this for 5 years now. i don't know what the problem is! if medicare or whomever has been paying for it, what's the issue. medtronic needs the info from you! the nurse yes fills out the paperwork, (yes, the ENDO isn't filling out insurance paperwork for their patients, my endo nurse filled it out too for me), but you have to provide it to them. you probably need to go in to see your doctor, are you going every 3 months for your checks, etc...?
Yep, I go every three months faithfully. The issue doesn't seem to be with Medtronics, it is with the 'chart notes' from my doctor's office - which the nurse can't seem to find properly.
The person I spoke with said that 'they' were waiting on chart notes from my doctor.
It was requested by Medtronic, no? Thus, why after all these years is Medtronic requesting these 'chart notes' if they've been supplying you w/10+ test strips/day for years? Maybe because it's a new year?
I truly do not know. I asked the nurse the same question and got an earfull. She just could not understand why, after 8 years with diabetes, that I haven't been DKA at least once or twice. Maybe she had a "happy lunch" and couldn't think straight?
BUT.... they will gladly pay for you to have a foot amputated or eye surgery!! Completely agree with the others...find a new Dr.
It's ALL abut money not prevention and it's the insurance demanding this information, not Medtronics. Or it was needed by Medtronics so they would be reimbursed by insurance. I just went through the same thing, explained to my Dr.that they were demanding his "chart notes"(basically giving a reason for testing 10 times) and I had to turn in a hand written log of one months blood sugars with times and dates, and I had to make sure there were 10..not 8 or 9..every single day! Please note, I've been doing this for almost 37 years. My Doc basically said "ridiculous, don't worry, I know exactly what to do to get it covered."
Maybe what you should have said to her is the reason for no DKA after 8 years is BECAUSE I TEST 10+ TIMES A DAY!!!!!
Good luck.
I agree with you. I also had to give a hand written 31 day record of blood sugar readings. One time Medtronic called me and said "you only provided a 30 day record and not 31." I told them "I filled out the form that you sent me and if it didn't have 31 lines and spaces on it, whose fault is that?"
Now every time they send me a blank form to fill out, I count and number the lines so there is not any question.
You sound like you have a great Doctor, I'm happy for you.
1) wake up, test bg 2) before eating test BG 3) before driving to work test bg 4) 2 hours after eating test bg 5) lunch test BG 6) 2 hours post lunch test bg 7) drive home test BG 8) get home, run 3 miles...oh wait, don't forget to test your bg! 9) post-exercise maybe, maybe not, maybe eat dinner and, you guessed it, test BG 10) 2 hours post BG, test BG ****AGAIN**** 12) stay up late? Maybe squeeze in another one, what if you have errands to run, what if you want to exercise more (when it's nicer out, I'll run 6-7 miles during the week, more on the weekends...a lot of times, I'll run a long run on Saturday and then a 20ish mile bike ride for fun, speed and recovery on Sunday...there's several extra strips in there...). Oh please give us her info so we can give her an earful back...she'd probably hang up though. She really ought to consider coughing up some test strips. Is she on the take somehow?
But acidrock, you forgot about when driving to work that driver almost creamed you at the light so pull over and test BG. Then lunch was late today, test BG. Now test again so you can eat lunch. Oh, what about waking up in the middle of the night not feeling "normal" test BG. Well, then there is that party, or going out to eat, or sleeping late, or getting up early, or spending the entire day in a car going somewhere on vacation. Oh, I almost forgot about walking up the driveway to get the paper. Am I low? Test BG. Did I really use a bottle of 25 strips in 2 days. Wow, I must need a blood transfusion I have donated so much to THE TEST STRIP. But DKA - nope. Hospitalized secondary to a low or a high? Nope. A1C 6.0 on 1-13-2012, and they wonder why I just look at my finger tips and they bleed? Mayumi, I wish you success in your work on getting the approval that is needed for you to keep yourself healthy! I too wouldn't be able to keep myself healthy if I didn't test continually - and I have the Dexcom also. But there are days where I test over 10 times per day! And my endo just says "It's a 6" with his eyes real big and a huge smile on his face. Priceless.
Please also consider writing to the head of the practice to express your concerns. This kind of poor knowledge regarding diabetes isn't just annoying, it's dangerous. Thankfully, you are knowledgeable enough to know not to listen to this woman. But the next person may not have your knowledge and may actually listen to her and test only three times per day.
Doesn't she understand that the reason you haven't gone into DKA is BECAUSE you test frequently and take care of yourself? Duh!!
Sheesh! Are you kidding me??? That's beyond absurd. Like we don't have enough BS to deal with in managing diabetes, now we have to deal with crud like this?? Ugh!
Oooh, that pisses me off.... She may have been a nurse 35 years but she clearly hasn't worked with Type 1 patients before. I test my son easily 8-10 times daily. Before all 3 meals, 2 snacks, bedtime, midnight, and first thing in the a.m., and any other time his BG seems wacky. And DKA is NOT a reason for getting a pump—if she thinks that you have to have a pump only if you're at risk of DKA, then she clearly has no idea what causes DKA! People with pumps are actually at HIGHER risk of DKA, not lower, because if the pump malfunctions or doesn't deliver insulin (and there are a lot of reasons why it wouldn't as you probably know) it can promote ketones. If you haven't had DKA with your pump it's a pretty good sign that it's working... Not to mention that your A1c speaks for itself. "If it ain't broke, don't fix it" — shame on her for quoting Medicare regs. to you when she ought to be concerned with what is working for you to control your diabetes. You have your pump to PREVENT complications, not because of them.
Bottom line, she doesn't know what she's talking about; insist, and I mean INSIST, on talking to your doctor about it, because there is absolutely no reason you should be denied test strips. In fact, if she were to cause you to have to give up your pump, you could make a legitimate case for a malpractice suit because she's preventing you from having the tools to manage your condition out of nothing more than sheer ignorance. Medicare be damned -- the need for frequent testing and the benefits of insulin pump use have been proven by research. IN particular, the findings of the DCCT (Diabetes Control & Complications Trial http://diabetes.niddk.nih.gov/dm/pubs/control/; the research very clearly -- and I mean VERY clearly -- shows that testing frequently is one of the key factors in avoiding the horrible complications everyone wants to avoid. The following is taken from the article with the URL I put in above:
>/p>
Elements of Intensive Management in the DCCT Testing blood glucose levels four or more times a day
Injecting insulin at least three times daily or using an insulin pump
Adjusting insulin doses according to food intake and exercise
Following a diet and exercise plan
Making monthly visits to a health care team composed of a physician, nurse educator, dietitian, and behavioral therapist
So if she gives you any more flack, just say, "I test frequently because the DCCT trial run by the NIH found that frequent testing and using an insulin pump are key factors in avoiding complications -- and it's obviously working since I have a great a1c and no complications. And since it's working, I intend to keep doing it."
