First-Level Appeal Letter re: Dexcom Denial.
I received a letter today from Oxford Health Plans, denying my request for CGM coverage. "Our Medical Director has determined that the request is: Denied - Not Medically Necessary."
My First-Level Appeal letter is below. This is the first round of a potentially long battle, but I'll see it through as far as I can, I promise. A price tag on my health? I don't think so. Here's hoping they listen.
"June 17, 2008
Clinical Appeals Department
c/o Oxford Health Plans, Inc.
PO Box 7078
Bridgeport, CT 06601-7078
To Whom It May Concern:
On September 11, 1986, I was denied a normal childhood when I was diagnosed with type 1 diabetes. My parents were taught to measure my food, test my blood sugar, and inject insulin into my body. We were taught about diabetes complications and how they may end my life. We were taught to plan for the worst and hope for the best. This was my mortality, handed to me when I was just a child.
On January 27, 2003, I was denied the ability to control my blood sugars with insulin injections alone. My medical team determined that my diabetes would be best controlled with an insulin pump instead of multiple daily injections. Thanks to my hard-working medical team and my personal dedication to good health, I started using an insulin pump. My A1Cs have been lowered and my risk of diabetes-related complications lessened, thanks to the benefit of this technology.
On April 15, 2006, I was denied the symptoms of a low blood sugar while I was at the movies. Thanks to my years of hard work and my desire to keep my diabetes as well-controlled as possible, my body was less sensitive to the symptoms of low blood sugars. Therefore, a blood sugar of 27 mg/dl snuck up on me without warning, leaving me moments from a diabetic coma. Currently, I experience severe hypoglycemic unawareness, leaving my body at risk for potentially lethal, undetected low blood sugars.
On May 18, 2008, I was denied a wedding without diabetes. Surrounded by friends and family, and with my husband-to-be standing proudly at the front of the church, I walked down the aisle. My mother cried, later admitting she always feared I would not see this day in good health. My blood sugar plummeted, without warning, before the first dance as a result of my excitement. I did not feel the symptoms. I spent my first dance with my husband clinging to his arm, trying to focus and waiting for the glucose tabs I had just eaten to raise my blood sugar.
On June 13, 2008, I was denied health insurance coverage for a continuous glucose monitor by Oxford Health Plans.
I am twenty-nine years old and have spent more than two decades living with type 1 diabetes. My wedding was barely a month ago. I am so excited to start a family with my loving husband. I will not be denied the chance to have a healthy pregnancy. I will not let my mother be denied a good night’s sleep because she’s worried her daughter will have an undetected hypoglycemic episode in the middle of the night. I will not let my husband be denied a healthy wife.
A Dexcom continuous glucose monitoring system receiver costs $800. The sensors cost $240.00 for a pack of four. Over the course of a year’s non-daily use, the Dexcom system will cost approximately $1,800.00.
Compare this cost to that of laser surgery to treat diabetic retinopathy. Or the cost for kidney dialysis or transplant. Or the cost of daily medications to treat high blood pressure, cholesterol elevation, or kidney disease. Or the cost of an amputation, as well as any attendant costs for rehabilitation and lifestyle adjustment. Please be advised that keeping me healthy now will save your company from greater expense later; preventative measures taken at the present time will mitigate the overall financial loss your company would otherwise incur in the future.
Denying my claim to protect your company’s bottom line is to deny my chance for a long and healthy life. You have marked my claim as 'not medically necessary.' You have boldly put a price tag on my health.
Your denial may cost me my life. I urge you to reconsider your decision.
Kerri Morrone Sparling"