The CGM Saga!

Posted 2 days ago to @BradP on another post:

" I am working on getting a Libre CGM though MS Medicade. I called a company and had them submit info to my medicade company and they said that they would pay it 100% BUUUUUT I had to be on Insulin and be checking my BG at least 4 time a day.

I am not on insulin but the company said if my GP doctor writes a letter explaining to medicade why I need a CGM the guy told me on the phone yesterday that he’s seen people who are not on insulin but check their BG 4 or more times a day, they actually won their case with just the doctors letter and medicade actually paid for it.

I hope he was talking about MEDICADE and not MEDICARE. But if they won their case without being on Insulin… I am sure I’ll win mine too I hope! "

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TODAY: 8/16/21

I get a call on my home phone’s voicemail saying this is my GP’s nurse and to call me back about the sensor.

I called back and got voicemail the 1st time… I gave the wrong number out so I hung up
I called again and my GP’s nurse answered and she sounded SOOO HATEFUL.

She’s like:

I talked to Susan and she refuses to sign off on your sensor. She said you are managing your diabetes with weightloss and are not on pills.

ME: Medicade said they would pay 100% no out of pocket, and the company I am going through said all Susan has to do was write a letter stating why I want one.

Her: Well, if you want one you’ll have to pay out of pocket.

ME: But I want one and Medicade agreed to pay for it!

Her: WELL YOU’LL JUST HAVE TO TALK TO SUSAN ABOUT THAT IN SEPTEMBER!

I wanted to hang up right then… But said FINE! in the most politest way I could and then I said thanks and hung up.

I didn’t even get to tell her why I wanted one. I wrote a whole list down on paper over the weekend of why I think a CGM would do me good.

The nurses aid just kept cutting me off… She was a real B****!!!

I am about ready to find a new GP. The one I am seeing Susan is just a NP… She’s not even an RN or anything and prob has NO idea about diabetes except the basics. I mean this woman didn’t even give me any pamphlets about diabetes and what to expect when I was first diagnosed! All that was said was "stay away from bread, sugar, pasta and I called you in some pills, and you need to go pick them up from CVS! "

I feel defeated and depressed… I really really really thought this NP would be okay with me wanting to better myself and keep control and a tight reign of my diabetes!

And when it comes to blood work at this doctors office… This NP doesn’t give you any print out’s with the test results so I can see my numbers myself. She just walks in with a computer and says: " your ________ was a little high", " _______ is elevated", Your A1C is ______ etc.

I want to see the damn numbers myself in black and white!

Any idea’s on what to do next besides find a new doctor?

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Find a different doctor. Where I am, the doctors are required to provide me with paper copies of all my test results and consultation notes either at the end of the session or mail them to me. Postmarked within 24 working hours of my appointment. Some are using an ‘online’ “MyChart” also to communicate and provide access to my records. Unfortunately these online portals are NOT user friendly and only allow limited access to the medical personnel I am attempting to contact. I also am anticipating a ‘fee’ to use this feature in the future, as in lawyers…there is a consultation fee.

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Have your GP recommend an endocrinologist for you to see.

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From a medical perspective, A1C of 7 and under is considered good, minimal complications.
You would have a better chance of justification if your A1Cs are > 7. Maybe ask for initial RX for 3 months worth, and review what impact it made to your A1C, and increase of % time in range.

Harder to justify if you are already under 7.

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Just to clarify. Nurse Practitioners are registered nurses with advanced degrees. Many have doctorate degrees but if she is an NP, she at least has her master’s degree in top of her bachelorette degree!
That doesn’t excuse her behavior in the least
Get yourself an endocrinologist and leave your old practice behind. You should be treated better!

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@wntrmute2 @mfg52lada Medicade will not let me see an Endo because of my A1C being below below 6.5 :frowning:

UPDATE:

I got a call from the CGM company this morning. He read me what my doctor aka NP wrote:

" REFUSED. TYPE 2 Managing with diet and exercise. Not on pills" !

He said “I don’t know why she wrote " Type 2” on there."
He said: " that it doesn’t matter if you’re type 1 or 2! It should be up to medicade to deny me NOT my GP!" And that " medicare has loosened up on requirements so medicade has too!" and that He’s never seen a doctor flatout refuse to help a patient!

So I just called GP left a nice voicemail telling the nurses aid that she cut me off from speaking yesterday and how she wouldn’t let me reply back and I told her everything that the CGM rep said above and give her my list of reasons that I wrote down on paper over the weekend of why I am wanting one and to call me back!

STAY TUNED!

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As a T1, I can tell you none of my PCP’s in past decade would write insurance paperwork for CGMs or any technology beyond basic test strips.

They all said they would leave the CHM paperwork up to an endocrinologist. My endocrinologist’s practice is large and they have staff that specialize in insurance/Medicare CGM and pump paperwork.

You write about your NP and GP, are any of these associated with an endocrinology practice?

Couple of thoughts which you might not want to hear.

  1. Your HgBA1c is good on diet and exercise. Live with that as the CGM may not provide you with information you can alter with insulin etc.
  2. Your country has a good health care system that pays for most but not all the bells and whistles. If you lived in the US, nothing would be covered unless you had a good job that paid for your health insurance or you chose to opt for the ACA which would cost around a thousand dollars a month USD.
  3. I believe you could decide to pay to see an endocrinologist out of your own pocket. That might give you access to a better, but more expensive, level of care.
  4. At a minimum, I would seek out a better NP/PCP. One that understands your goals better.

To reiterate, your control is GOOD! 6.5 is a number that has been shown to significantly reduce complication risk! That is my current number and my endo is satisfied that is excellent for me. Why spend money on something that may give you info but no way to affect the results.

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I was assuming you were in Canada for some reason. Sorry for the error. I still believe my points were salient.

#2 Nope I am in the :us_outlying_islands:. :us:.

#3 I shudder to think about what out of pocket would be. :sweat_smile::expressionless::confused::eyes:

#4 in the process of doing that now!

My A1C is 5.4 right now.

Mine runs 6.8 to 7.2 on a CGM. It ran 6.8 to 7.4 on needle injections 6 times plus per day. The difference is: My bg used to vary from 38 to over 550 on needles. It now varies from 55 to 250. I am always 80% within my goals of 70 to 190bg. I got a pump after my C-peptide showed I was type 1. My original diagnosis was type 2 and I believed that for 3 years, until I got the C-peptide test. My official diagnosis is Type 1 with Type 2 tendencies: LADA, Latent autoimmune diabetes in adults. I had to switch GPs 3 times to find one who listen to what I had to say and do the tests to verify the correct diagnosis. I believe there are other tests to determine type, but it appears to me there are so many varieties/different diabetic conditions that just by classifying them as type 1 or type 2 is like classifying all dogs either large or small. I am also seeing a trend to using ‘time in range’ other than A1C, as in my case the A1C did not really show what my BG was doing throughout a short time, but only on a three month interval. I am no longer tired all the time, I see no more bubbles through my eyes, as if I am under water and my eyes are not dry and scratchy anymore. I have ‘original medicare’ in the U.S. It costs more per month but it is NOT managed medicare, in that it does not require me to see a GP and get a recommendation to see a specialist from him/her.

Really with a 5.4 HgbA1C you don’t need a CGM IMHO. Free up the resources for those that need it! How much more normal do you want to be?

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I do have reasons of why I am wanting one… I am not " Just wanting one to have one"
@wntrmute2 .

  1. I want to keep my a1c low
  2. I want tight control
  3. I test 5 times a day
  4. testing 5 times a day HURTS!
  5. I want to try to avoid complications
  6. I want to try to avoid going back on pills or my worst fear Insulin for a long time!
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So you have good control as evidenced by your normal A1C.
You cannot active “tight” control without insulin AND you don’t need BETTER control as evidenced by your normal A1C.

You probably don’t need to test 5X as you cannot change your medication to effect a change.

Your current A1C will avoid complications but I am gathering you do not believe the medical evidence and it is not surprising that with a normal HgA1C and being controlled with lifestyle modification they are reluctant to spend thousands of dollars per month making very good control no better.

Your problem is that you do not fall into the category that you want to be in.
The insurance companies and even the government insurance companies like Medicaid, have strict rules.
You need to be on insulin
You need to have an a1c over 7%
You have hypoglycemic unawareness.

It’s really not the fault of your primary care group. They are putting themselves at risk if they lie. The requirements are clear.
I really wish you could get them covered just because you want to have this tool. And that it would help you in that regard.

Their rules say that a cgm is not medically necessary in your case.
I don’t see a way around it, you will likely need to pay out of pocket for it.

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You may want to consider sugarBEAT, once available in US. It is targeted toward T2, and likely lower cost. I think release has been delayed in US due to COVID.

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Ask for a prescription for a Libre or Libre 2. They are much more affordable out of pocket and discounts are available that could take it down to about $35 a sensor from some pharmacies. When I was on the Libre I was paying about $75 a month.

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Great solution. I totally forgot about Libre.

I agree with “M” you need to get an Endo doc. What you ran it is true with any CGM.
Another problem I ran into with Medicare is that I wanted to go on a pump , searched a yr , found but Medicare wouldn’t pay for even though I’m on insulin. The issue was that I make to much insulin on my own , (epeptide test” so they wouldn’t pay for it.