Anonymous asked in HealthDiseases & ConditionsDiabetes · 1 decade ago

Continuous BG Monitoring... geared up for a fight?

At least in Massachusetts, HMOs don’t cover Real Time BG monitors. Our daughter is a good candidate for a single case negotiation in that, despite the level of parental involvement, her BG continues to be in poor control. There isn’t a consistency to her highs and lows either. She isn't a food sneaker, nor does she stash what we give her. We are excellent parents. We were told some diabetics are just like this - with the roller coaster numbers. Some kids outgrow the rollercoaster, but with every year that goes by, it looks less and less like she will. Gina has 8-10 BS checks per day. Her pump is RT BG compatible.

Did you succeed in getting a single case negotiation for a Real Time monitor? What are your recommendations in my pursuit? The request was faxed and included everything they wanted. The follow-up lies with me. I’m told call frequently and faithfully, I’m planning on once weekly. What else do you recommend?

3 Answers

  • 1 decade ago
    Favorite Answer

    We are in the process of getting a pump and also trying to get the CGMS as well. I know insurance covers the pump no prob, but most insurance companies don't standardly cover CGMS. It was recommended to me to write my own letter to the insurance company along with giving them proof of her glucose ranges and to consistently call them. We are on the number roller coaster as well. Good luck to you and hope you are able to get it. I've heard nothing but great things about them and hope to get approved as well...wouldn't it be great to have the "heads up" before a high or low? Too bad the darned insurance companies can't get it through their heads/politics that it will SAVE them money in the long run since diabetes complications cost a LOT more and people in good BG range have LESS complications. Someday....I'm right there with ya so hang in there and be persistent!!!

    Source(s): Mommy to Type 1 dd
  • 1 decade ago

    I was having the same trouble (NY). My son has the insulin pump, but we have been put off many times about the continuous blood glucose monitoring. I talked to a rep from minimed who helped me. My son goes to the ER in DKA about 4-5 times in the past year. Yes, I know you are great parents, and dedicate your life to helping your child. That's not what's wrong here. what is wrong is that you have beat the insurance companies into doing the right thing. This is how you do it. Every single time your childs' BS is over 400, go to the ER. This costs our ins. 1$3K at least, every time, more when he's actually admitted. The BG monitoring would stop all those visits. I sent all his ER visits to the minimed rep and he got it done in no time at all, because numbers don't lie. Don't give up, and don't despair. My heart goes out to all.

  • Anonymous
    1 decade ago

    My daughter is 2 and was recently dx'ed, so I don't know anything about this personally. But luckily I belong to a bunch of email groups, and I remember one was recently talking about how to get a CGMS denial overturned.

    Okay, I've found it now ... it's the parent's email list from the website. This woman had help composing an appeal letter to the insurance company that apparently worked. If you don't want to have to search for the email, send me your email address and I will forward it on to you. I don't think the poster would mind, because they said that they will forward their appeal letter to anyone who has been denied because the device was deemed "investigational." Even if that wasn't it exactly, maybe someone there can help you.

    Good luck!

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