I don't need a CGMS but


(khurt) #1

I want one.  I'm tired of the prick/test cycle.  I'm tired of wondering if it's really that cold/warm in the room or am having hypoglycemic event (then prick/test again).  But ... my endo says I have really good control.. And I do.  My last A1C was 6.2 and the one before that was 5.9.  So he does not think health insurance will provide for a CGMS .. so he won't prescribe one.  What can I say/do to change his thinking?


(hcole) #2

I'm in the same boat as you.... I want one and my insurance company won't cover it because I have good control, and the diabetes clinic says it's unneccessary because I have good control... sigh.  Let me know if you come up with anything!


(khurt) #3

Aparaently the word p-r-i-c-k is on the list of "YOU CAN'T SAY THAT" words.  So I can't p-r-i-c-k my finger?


(brynnie) #4

Hi Khurt - I too have really good control.  All of my A1C's in my memory have been below 6.5.  I recently got a CGMS, though, in part by having a supportive doc and in part by getting in touch with Medtronic.  I got the insulin pump/CGMS combination, and Medtronic will make it a part of their mission to help you get insurance to cover it.  I don't know what the other companies are doing, but you can check.  I had a personal contact at Medtronic, who I spoke with on the phone on a first name basis, for a couple months.  Had her direct number, so that I had consistent communication with her.  But part of Medtronic's effort was getting my endocrinologist to write a really really good letter, describing the benefits of having a CGMS.

If your doc is not being supportive of being proactive in your care, you might consider seeking out a new doctor.  Or at least ask him why he's playing the part of deciding what your insurance will cover.  Being diabetic means a constant battle with insurance companies, and part of your doctor's job should be helping you in that battle, and not shooting you down.  His job is to prescribe treatments that will help you, and not to decide what your insurance will cover.

As for the medical need for a CGMS, there's this: being in really good control means a higher risk of hypoglycemia, which is immediately dangerous.  Being on a CGMS can prevent that: it can wake you up if you blood sugar starts to drop during the night, and it can alert you to a sudden drop in glucose.  I'd had recent low blood sugar scares that made the CGMS a good idea, so if you've had a history of low blood sugars, make sure you're telling your doctor about them.

Some insurance companies are more willing to cover the cost than others.  Aetna and United are both supposed to be pretty good... I know elsewhere on the JDRF site there is a list of those companies that are approving these devices.  But even if yours isn't on the list, try it - change in the system only happens when we push for it.

Also, please know that the CGMS is not a magic device.  I still test several times a day when I'm wearing it, and sometimes it's not as accurate as I would like.  It is helpful when i'm just wondering what's going on (for example, during exercise or after a meal, is my blood sugar dropping or rising, etc.).  Also really interesting was seeing that right after breakfast, my blood sugar was rising up over 200, and then dropping quickly - I had no idea since 2-3 hours later it was normal again.  By taking my bolus about 20 minutes before I eat, that's no longer happening.

Good luck.


(memery64) #5

I really want a CGMS too! I'm 44 years old and my A1C  needs to be lower. My doctor says that my Insurance company (Health America) won't cover it so for me "not to waste my time". I can't just sit there and do nothing. I'm going to fight to get one. Would the insurance company rather pay for an artificial limb or a seeing eye dog if I go blind? I don't think that my doctor would take a risk for me or fight for me with my insurance company. Please don't give up... keep fighting until you get one!

Hugs,

Marcie


(brynnie) #6

Hi Marcie - I can't believe your doctor said that to you!  I highly recommend calling the CGMS companies.  Put the healthcare industry to work for you - they are trying to make a sale, and so find one that will go to bat with your insurance company.  If you can, consider shopping around for a new doc.  You have enough to deal with, and having a supportive medical team will help immensely.

Bryn


(memery64) #7

Thanks, Bryn! I haven't been to my doctor in awhile because I felt she always put me down. I can do no right in her eyes. I told her that I lost a little weight since the last time I was there and she laughed it off. I told her I took one of those over-the-counter A1C tests and she just rolled her eyes and said they're not accurate. She always makes me feel like there's not alot of hope for me. I beg to differ! I'm willing to do what I have to to get a CGMS. I've thought about changing doctors but I've been with her for so long...sort of like a bad marriage! LOL

Hugs,

Marcie

 


(caspersfriend) #8

I agree you should look for a new doctor Marcie.  The job of the doctor is to help you manage your condition.  It doesn't sound like she is doing that.

 

As for the original question, I can look directly at my insurance company's website and it talks about the "protocols" for them to cover a pump and/or a cgms.  One of the things they list for cgms is frequent lows without knowledge.

Then I went to my doc and asked if I could get some further "education" (ala meet with one of the nursing/educator staff) to find out more about options.  I figure once I do these things, if I need to, I can contact the manufacturers to see what they can do to help me. 

I figure the company may be willing to give the computer part if insurance will cover the part you inject (the way meter companies make all their money off of the strips).  If not, I will start saving up for the computer part, and tell them I will pay cash for it if they can get the insurance to cover the injectable part.

Good luck!