CGM: Denied Once Again.
Dear Insurance Company,
I got your letter yesterday. I opened it up and saw your second denial.
"Our Medical Director has decided to uphold the initial adverse determination because this monitoring system has not been proven to be any more effective in the management of diabetes mellitus than the standard monitoring."
I test my blood sugar 15 times per day. I test when I wake up, before I eat, after I eat, before I exercise, while I exercise, before I sleep, and sometimes in the middle of the night. I also test when I feel "off." I try to catch the fluctuations as often as I can and I respond accordingly. Unfortunately, I am only seeing snapshots with this "standard monitoring," instead of the streaming video I get from a CGM. Maintaining tight control is difficult with only snapshots of information.
I got married two months ago and my husband and I are planning to start a family in the next year or so. As a type 1 diabetic for over 21 years, preparing my body for baby is a bit of a daunting task. My endocrinologist has told me to bring my A1C as close to 6% as possible. I am starting the Pregnancy Clinic at Joslin at the end of the summer and am working hard to run my numbers tight. Unfortunately, running at a tighter clip results in more low blood sugars.
Sometimes I don't feel my low blood sugars. I've felt perfectly fine and then tested to see a result of 38 mg/dl or 41 mg/dl or 45 mg/dl. These are not safe numbers. As a result of my efforts to lower my A1C, it takes longer for me to feel the lows. I have hypoglycemic unawareness. A CGM would keep me safer from these undetected lows. And when I'm pregnant, it would protect me and my baby - at no extra cost to your company.
And in January 2003, my then-boyfriend woke up to find me unresponsive and sweaty. He tried to get me to drink juice but I fought him off. The paramedics were called and it took three of them to hold me down and administer glucose. After a tube of glucose gel, my blood sugar was 44 mg/dl. Had my ex not woken up, discovered I was low, and called the paramedics, I may have died. Let's just think about that for a minute, okay? Dead, thanks to a low blood sugar that I did not wake up for. A CGM would have warned me about my falling glucose with a loud and relentless BEEEEEEEP. I would have woken up, tested, and most likely caught this low at 60 mg/dl instead of whatever low I achieved that morning.
While I believe that your company should respond to these issues on an empathetic and proactive level, you may only care about the financial aspects of this issue. I offer the following:
The Dexcom unit I am using was given to me by the company. You would not need to purchase the receiver unit or the transmitter at this time. This is a savings of $1000.00. What I am looking to cover is the cost of Dexcom sensors, which are $240 for four sensors. Over the course of a year, these sensors would cost $2,880.
To offset this cost, I would be testing less frequently. I would go from testing 15 times a day to approximately 7 times, saving $5.00 a day. Over the course of a year, I would be using 2,920 less test strips. With test strips costing approximately $1.00 apiece, this would be a savings of $2,920 per year. ... Wait a minute, that's saving more than the sensors are costing. Looks like you guys just made $40, not to mention co-pays for these items!
We should also factor in the cost of an ambulance ride, if I were to have another low that required assistance. Medical intervention could cost upwards of $1,000. The CGM is a measure that could prevent this cost from occurring.
These are just the immediate cost savings to your company. Never mind the savings that will accrue long-term, when my body remains healthy as a result of achieving a tight A1C instead of developing expensive diabetes-related complications.
Overall, it makes more financial sense to invest in a CGM for me. Proactive measures will keep me from costing insurance companies large sums in the future, when more serious issues may arise as a result of several decades of diabetes.
And, as an added bonus, I will be healthier. Imagine that.
I am looking forward to your response.
Kerri Morrone Sparling