Thursday, May 24, 2012

CGMS? Yes please!

A lot of insurance companies do not routinely cover Continuous Glucose Monitors (CGMS) for children with diabetes.  It's so absurd really, and it frustrates me that parents have to fight so hard (submit months of BG logs, get doctors letters) to get this valuable information in their hands...or do without it.

A CGMS is a sensor that a person wears.  The sensor is inserted into the interstitial fluid under the skin where it reads the blood glucose levels and wirelessly transmits them to a receiver.  We chose the Medtronic pump because it has the CGMS receiver built into the pump itself.  I already knew I planned to fight for this technology.  The sensor reads the BG levels every 5 minutes 24 hours a day.  We will still have to test Seth's BG 4x a day via finger prick to calibrate and test for accuracy...nothing is perfect.  But the information this will give us is so valuable, it is worth it.

Let's talk about that for a moment.  Right now we test Seth's BG 8-10x a day.  But we only get a singular reading and it doesn't give us any context unless we test multiple times within a certain time limit.  For example a 70 means Seth's BG is good and in range and during the day, I'm okay with that.  But at night, I am uncomfortable sending him to bed like that because I don't know if that is a stable 70, a 70 that is heading lower or a 70 that is going higher.  So I have to treat it like it is "low".  BUT, with the CGMS, if calibrated and using an accurate sensor, it will show me if it is a stable number, a number that is heading down or a number that is heading up.  VALUABLE information to help me keep Seth's numbers more in range.  I can make more minute corrections to keep him more tightly in range.

The more you can keep a diabetics numbers in range, the more you can help prevent potential long term damage.  I will do anything I can to help prevent this.

The conversation I had with my rep at Medtronic went something like this:

Me:  I am interested in ordering the CGMS system with our pump.

Medtronic:  We generally recommend ordering the pump first and once you have received that, then ordering the CGMS system, because insurance generally fights those a bit more and we would hate to have your pump delayed for the CGMS.

Me:  Sounds good, lets order the pump.

I called again the day they shipped the pump

Me: I am ready to order the CGMS system for our pump.  What is the process for that?

Medtronic: We will put the request in with your insurance.  They will then have 14 days to make a decision.

Me:  Perfect.  So here is what we are going to do.  We are going to make the request.  If they do not approve the request for a CGMS, then the day after we receive the denial, we will make another request and we will continue this cycle until they say yes.  If they need anything from me to help make this decision, please let me know so I can send it in.  I do not want to hold this process up.  They have met a bulldog who is fighting for their child.  I will not stop until we have is that important to me.

Medtronic:  We will submit the request right away and be in touch as soon as we hear.

3 days later my rep called me and said that my insurance had approved the request.  They agreed this was medically necessary for diabetes and as such would cover it.

I welled up and my jaw dropped.  I couldn't believe it.  I was prepared to fight and battle for this.  I wasn't prepared for a simple, we couldn't agree more.

So, we go in next Monday to be trained on the insertion of the CGMS sensor.  The needle is a lot bigger than the pump, so we got some prescription numbing cream.  Wish us luck!

1 comment:

  1. I am so thankful for our Dexcom CGM! It is such a great tool :) I am so happy for you that you did not have to fight the ins. co. and will have yours soon. I found you from Denise's blog-nice to "meet" you.