CGM - Yes, but Pump - No?


(BrianC) #1

I've discussed (briefly) with my doctor the idea of getting a CGM, but like many people who are not on a pump, my insurance won't cover it. In fact the only way my insurance (Blue Cross) will cover it is if I have a pump and "A history of hypoglycemic unawareness without preceding symptoms, as evidenced by altered level of consciousness or seizures and as documented in the patient's medical record."

Well I'm not on a pump, and even if I were, my hypo situation isn't and has never been as they would require.

I don't have much interest in a pump (for several reasons, but one of them being the 24/7 hooked up issue) and I do believe the most important thing in control is knowing your sugar level. My doctor mentioned how some people use a CGM periodically, for certain amounts of time. (After all, it doesn't replace the traditional test anyway.) 

Anyone out there doing something like that? Using a CGM, but not on a pump?

Anyone out there ever fought your insurance company for coverage and won?


(figure skater girl) #2

im on a pump but i think my mom is going to fight our insurance company to cover the cgm. and trust me, if she does, she will win.


(joe) #3

[quote user="BrianC"]

I've discussed (briefly) with my doctor the idea of getting a CGM, but like many people who are not on a pump, my insurance won't cover it. In fact the only way my insurance (Blue Cross) will cover it is if I have a pump and "A history of hypoglycemic unawareness without preceding symptoms, as evidenced by altered level of consciousness or seizures and as documented in the patient's medical record."

Well I'm not on a pump, and even if I were, my hypo situation isn't and has never been as they would require.

I don't have much interest in a pump (for several reasons, but one of them being the 24/7 hooked up issue) and I do believe the most important thing in control is knowing your sugar level. My doctor mentioned how some people use a CGM periodically, for certain amounts of time. (After all, it doesn't replace the traditional test anyway.) 

Anyone out there doing something like that? Using a CGM, but not on a pump?

Anyone out there ever fought your insurance company for coverage and won?

[/quote]

hey Brian,  a few thoughts:  many folks have to fight insurance.  I know BCBS often denies the first request for a CGM.  if you really want one, and they formally denied coverage,  then start an appeal.

BCBS in NJ covered mine, but it is a messed up story (ill tell you if you really want to know).  The data is good from the CGM but the accuracy and repeatability are terrible - still, the data is good.  The data will make it easier for you to figure out your basal requirements and if your eating habits and your bolus shots are working.  it helped me a lot in pump tuning.

Yes I have heard of people on CGM without a pump.    I have a question for you though - the CGM sensor is pretty much exactly like an pumper's infusion set - in fact you have to tape them down a bit more than you would have to for most infusion systems out there.  Then you clip the CGM monitor to your belt.   Soooo my question is how is this different is this, relative to being hooked up 24/7 to a pump?  The communication between the sensor and the monitor is wireless, but still, it's exactly like a pod and not too far from a traditional pump situation.  What was your expectation for the CGM sensor/monitor system?

anyway I hope you can get the system if it's what you want.  Mine did help a great deal.

cheers


(BrianC) #4

[quote user="Joe"]how is this different is this, relative to being hooked up 24/7 to a pump?[/quote]

Totally valid question. 

I want to use the CGM to augment my regimen, which is all it can do since it still needs to be used in conjunction with traditional finger-sticks. I might not, and likely wouldn't, use it 24/7. My doctor mentioned how he has some patients who've done this, using the CGM for a week or two a month, as a guide. (And given the out-of-pocket costs, that may be the only way I could afford it.)

But to your question, it's different from a pump because it CAN be removed for several hours or days at a time. 

Part of my issue with wearing a pump is my work as a stage actor, where costumes, quick-changes and other performance issues might be problematic with something like that attached to me.


(joe) #5

okay I see, but the sensor is not invisible, neither is the transmitter - so I guess it depends on where you insert your sensor (and what your wardrobe will cover) if you planned/unplanned to wear it during a gig.    Due to the extra tape - -I tend to notice my sensor more than my pump infusion set.  oh yea, once you get a good sensor location and you are getting good readings, ripping it out before 10 days is a bit of a heartbreak, well, it is for me anyway.

good luck!


(BrianPQuinn) #6

Brian,

It is possible from time to time to get a sensor to check trends and see what is going with your numbers. Is this something your endo might offer? Mine did with the Dexcom system. You may want to see if he does the trend evaluation, usually insurance will cover that.

However, if you are dead set on trying to get a sensor you might want to talk to Medtronic and see what they can do. With the amount of people they have and stuff they tend to be able to get stuff past insurance more often and have the people who are willing to work with you and help you out in getting the coverage you need. They were able to help me with BC/BS of NJ to get the sensors through which was nice, however I switched to another company because I had issues with how they were handling insurance claims, but that is another story. You may want to try to deal with them for the coverage.

As for the pump, I was in your boat of I like how things are going for me and it works, why switch and as for being on the stage it makes some sense. However, if you truly decide you want a pump there are work arounds and stuff like that if you truly want or feel things would be better that way.

Good luck though! If you have any questions feel free to ask me.

Brian


(DocHam) #7

I actually cared for several patients who had CGM who were not pump users. Typically its easier for pump users to get coverage because they have to test their blood glucose more frequently to qualify for the pump. Many times, they look at the frequency of blood glucose monitoring as a gauge of control and even dedication to control. Insurance companies (rightfully) don't want to cover something that might do you harm.

It takes a strong letter from your physician demonstrating need. Need is typically equivalent with hypoglycemia unawareness or very erratic/unpredictable control. If there is not a medical necessity, its an added luxury.

This is the breaks unfortunately. You need a doc who knows what he/she is doing to write an appropriate letter.

A word about pump resistance:  having a CGM WILL make you want a pump. I would estimate that I make at least 6 adjustments a day based on CGM information - micro-boluses, temporary rates, etc. And that's the very minimum. That is on top of the 3 meal boluses per day. The data is real-time for a reason. I think it is more useful for people using CSII as therapy modifications are also real-time. If you are looking to use it for dosage adjustments, use your physician's blinded retrospective unit. It will save you money and headache.

I very much resisted the pump for a long time. Unless you are an adult entertainer, it can be easily concealed.


(BrianC) #8

CSII?


(mcbaio) #9

CSII= Continuous Subcutaneous Insulin Infusion (PUMPING)