Denied for CGM Coverage

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The insulin my doctor prescribed to me isn't covered by Express Scripts my prescription insurance. I have to pay $150 for it. I think this is insane, I'm sick of paying for insurance coverage and then be denied the medication my doctor prescribes......

I am so uncontrolled and would love to have a CGM.  It might show patterns and help get me controlled.

10/02/08

 

to Whom it May concern: 

 

I to was denied for the CGM system but you just have to keep on trying and along with your doctors note you have to write a not too on your dailly activities on how the diabetes effects you.  I am the first to be approved by Keystone Healthplan East insurance which is one of the hardest companies to get it approved.  I think the only way I got it approved was that my appeal cordinator had pity on me and siad that I needed it to be approved.  I have no feeling when I am high or low.  I can be 600 or 35 and I would never know it. the CGM has helped me so much.  I feel so much better

 

Thank you

 

Ellen Gaffney

Norristown PA  l9401

Gina:

 

If you still do not have a glucose monitoring device, please contact me. I have three and all of them are one step machines. I also have some strips that I will share with you.

 

Tom Morris

tom.morris205@yahoo.com

I can't answer all of the questions you have posed in your lengthy posting, but all I can say is WE ARE NOT READY FOR SOCIALIZED MEDICINE in the USA, which is exactly what you are proposing. I can't explain why illegal immigrants get free medical coverage and free education here in California, but they do, to the tune of about $14 Billion annually that we, the taxpayers pay for. Do you want even higher taxes? Be happy for the fact we have such advanced medical research in our country. BTW I am not in the medical profession, but do have excellent medical coverage through my spouse's employer.

The monitors are in an experimental stage which means they are still under a study

I have 6 diffrent moinitors and each will give me a diffrent reading that has been taken at the same time (fingers are sore so is arms I probally look like a junkie lol)

So the insurance co see them as not a reliable source to give accurate readings and I agree with them .

No I do not work for any insurance co I am  a disabled citizen

who has diabetes If anything more testing should be required until there is proof the are correct

Make your voice heard by all means but volunteer to help test monitors also it is easier to help out then raise cain

I don't want to make light of your situation.  Your insurance should cover the monitor.  However, a great many of us have a much bigger problem, and not just no health insurance.   I was my Dad's live-in asisstant until May 12 of this year, when he went to Heaven.  I handled the bills, took him to doctors, watched over the caregiver, cleaning lady, yard and pool maintenance. 10 days after his death, I relocated to northern CA to become a live-in nanny.  I receive room, board and a small salary.  I accepted this job because the salary was enough to cover my expenses and I only had 30 days before I had to be out of Dad's house. In the midst of all of this was the funeral, taking care of Dad's possions, getting my stuff packed into my motor home, putting it in storage, etc.

 

After arriving here, my budget was shot to pieces by CA state laws.  For some reason, Wal-Mart is not allowed to charge only $4 for some of my prescriptions.  Several prescriptions that were $10 for 3 months are much more expensive here: $24, $36 and $48.  I live just outside a national forest.  Prices here are outrageous!  Most of my personal items such as shampoo, conditioner, etc. cost $2 more per item than I paid in NV!  Same brands, same store, higher cost.... car insurance and registration is so much higher that I can't drive my car.  It sits in my employer's driveway, unused.  I start it up once a week.

 

In NV I had county medical assistance.  I had thought I wouldn't need it here, but that is not the case. I applied and was told I qualified for 'partial help'.  Meaning, I have a $170 per month cost share.  That's every month. 

 

Every day I take 2 over the counter medications and 11 prescription medications. Then there's my Diabetes supplies.  Fortunately, I'm not on insulin so it's just Metformin, test strips and lancets. If I can manage the $170 each month, I can get all my medications.  Otherwise...

 

There you have it. You can see why your problem seems small compared to mine.  And, there are people out there who are worse off than I am and my problem seems small to them.

 

Now, for the solution.  Deport the illegal aliens.  That means smaller class size in CA.  Smaller classes means needing less money.  Needing less money means LOWER TAXES.  No illegal aliens mean less need for social services, ie, food stamps and medical benefits.  That means more money in the system so medical benefits can be given to more people.  In my area, a single person can only earn $600 per month for full benefits. That is way below the poverty level.  But it's the same everywhere.  As budgets shrink and the need grows, they make the cut-off lower and lower. That's the only thing they can do to stay within the budget.

 

so let me tell my story.  on disability as a teacher in north carolina.  have the best insurance plan available.  pay over $600.00 per month for spouse.  $60.00 per month psychologist.  $110.00 per month copays on meds.  $50.00 per month insulin, strips and supplies.  over $820.00 per month for medical.  that's 25% of my disability.  but somehow i make it.  God is good.  If we would depend on him instead of the government, we might find things work out so much better.  that's the only way i can explain it.  i know we've got problems, but this is the best nc has to offer.  just think what a government sponsored  medical program would be like.  i had an mri at the orthopedic clinic instead of the hospital $700.00.  stress test at the hospital $7,000.00 and they (hospital and doctors) had the gall to send me to collections for a little over $1200.00 i was trying to pay less than a year later.  the doctors and hospitals want government healthcare.  be careful what you wish for- you might get it!!

Here is a copy/paste answer/explanation for E/I:

There is insufficient evidence to support the prolonged use of continuous glucose monitoring devices as an adjunct to home blood glucose monitoring for improving long-term glycemic control. The potential advantages of adjunctive use of continuous glucose monitoring devices in managing persons with poorly controlled diabetes are theoretical. There are no adequate prospective clinical studies in the peer-reviewed published medical literature demonstrating that the use of continuous glucose monitoring devices results in durable improvements in outcomes of individuals with diabetes. 

The section in italics  is the overall explanation for E/I products and services. Generally for something NOT to be considered E/I, there has to be long-term studies proving beneficial outcomes.

(Yes, I work at an Insurance company.)