Jenny was kind enough to remind me that my last blog was nearly a year ago. Yikes. Talk about not actually writing a blog! Indeed, it’s true when I say that I’ve been busy with graduate school and yes, appeals. I am all over the appeal process like the summer sun on the garden bed. Regence BCBS may have thought the summer of my request would never arrive, that the cold dark winter of denying me a CGMS was their forever-season. But the seasons always turn, don’t they?
But today!! Today I mailed a heavy envelope of hard-hitting THIRD APPEAL documents to shock them into submission, one hopes. I relied heavily on the letter our tudiabetes friend Marcy (and disappearing Rick’s advice too) provided for me, although I adapted it to my own specifics and added in more citations. I have demanded of Regence BCBS of Oregon to provide me, in writing, the exact documented reasons why they claim that the CGMS is still investigational - even though it is approved and out of the Pre-Market phase by the FDA.
Now that the letter is sent, I can do nothing more. However, they have been told, in no uncertain terms, that if there isn’t a favorable outcome to this LAST appeal (which is the IRO - Independent Review Organization phase) that I’ll be forced to contact the Oregon Business something or other official - insurance sector for further investigation. I know they have succeeded in overturning a decision by an insurance company for a woman who had a cgms denied for her son. So, even though I know the insurance co’s are underhanded and out-of-sync with the reality of living with diabetes, I still am hoping that I get prior approval. Hoping, wishing and praying - but now I’m going out to live life and wait as patiently as I can.
Please celebrate REQUEST FOR CONTINUOUS GLUCOSE MONITOR - DENIED - DAY WITH ME ON JULY 1ST
And yes, when are Minimed and Dexcom going to make these systems within the affordable range for everyday people??
