I've been using a Dexcom continuous glucose monitor for nearly 18 months now. In all that time I haven't been able to get my insurance company (Aetna) to cover the costs. I just heard from Dexcom that Aetna has made them a provider, though there are still many hoops to jump through before I get reimbursement. I'll post with more details once I have those.
Most (all?) of us with diabetes have been denied coverage for thing needed to maintain control of our diabetes. In fact, insurance coverage for chronic illnesses is fairly bad in the US (and often worse in other countries). Today the Wall Street Journal published a short article on getting coverage, Pushing Back When Insurers Deny Coverage for Treatment.
They've provided a list of things you can do to improve your chances of getting insurance to cover treatment.
Find out what led to the denial
Learn how to appeal the denial
Take detailed notes, including dates and names, when you talk with the company
Get a copy of your plan's detailed benefits language (Evidence of Coverage)
Find out what they consider to be medically necessary
Sometimes I've talked with insurance companies to find that the doctor's office has used the wrong diagnostic code when submitting the claim. Often the insurance company will even tell you which code they should have used, or which codes they've used in the past.
Persistence pays off in some cases, like the parable of the persistent widow. Just remember to be polite to the person you speak with at the insurance company - they're generally following rules and are usually helpful. And many situations are open to interpretation.
Have you had things that were denied that you managed to appeal successfully? What approaches worked for you?
If you're a regular reader of this blog, you've probably seen some references to TuDiabetes.com. Have you visited this awesome social networking site? It's an amazing resource for folks whose lives have been changed by diabetes. So if you have diabetes, any type of diabetes, or you have a family member or good friend with diabetes, this is an excellent place to join.
My good friend Manny Hernandez started TuDiabetes in March of last year, it now has almost 4,400 members. They support each other in various groups, sometimes get together at organized events and generally share information and help each other live better with diabetes.
If you understand the importance of work like this, now is a good time to support TuDiabetes and its work. Recently Manny started the Diabetes Hands Foundation and he's trying to put together a fund that will enable the foundation to work in a more direct way for folks with diabetes. If you can spare even $10, that would go a long way towards helping them reach their goal by the end of September.
While you're at TuDiabetes, check out their Word in Your Hand competition. They're looking for photographs of your hand with a single word on it that captures how you feel about diabetes. Check out the winners from last week, there's a lot of creative folks out there.
Then think about entering one of your own pictures in the competition. All of us with diabetes need a hand, and yours could be one of them.
Last Saturday dawned as a beautiful if chilly day in Portland Maine. I was up around 6:15 AM (45 degrees C) to put my triathlon gear into the car and by 8 AM I was on the road to beautiful Biddeford for the first ever Mainiac triathlon.
I put all my stuff at the transition area and talked with some other folks before the race started. As I wanted to keep my blood sugar under control, I'd decided not to eat any carbs for breakfast and I reduced my basal to 50% for 2 hours about 2 hours before race time. Thanks to my Dexcom, I was able to watch my BG creep up until it was around 215 before the swim started. So I ended up taking a small bolus before removing the pump and zipping into my wetsuit.
Then off to the beach with other triathletes to wait for the pep talk before race time.
After a recap of the rules and a lovely rendition of The Star-Spangled Banner, we all walked down the beach to the official starting point.
There were four swim waves separated by 3 minutes. I was in the third wave, for the over-40 men. So we got to see the first wave rush towards to the water while we waited nervously. As someone said, it was a beautiful photo moment.
After a few minutes of smalltalk it was our turn to rush towards the cool blue Atlantic water. Let me just say that the swim was a lot harder than I'd expected. Although I'd done several miles of swim training overall, the combination of the colder water and the slight current made this part a lot more difficult than I expected. So I made slow progress in completing the 1/4 mile, and I was fairly worn out when I did make it back to the beach. (Note to self, I need to learn to do front crawl!)
Then it was a 100 yard dash up the beach to the transition point. I dried quickly and got my pump back on as I changed into my bike gear. My blood sugar had gone up slightly, so another minor correction and a quick drink of some electrolyte mixture before getting on the bike.
The bike ride was 14.7 miles and it was really flat with nice scenery all along the way. Much of it hugged the coast and the breeze was gentle enough that it neither helped nor hindered. But I did notice my legs cramping up during the last few miles. I stopped twice to get a look at the Dexcom and drink some extra fluids, and my blood sugar was finally getting closer to a normal range.
Getting back to the transition area, my blood sugar was around 150. A relatively quick change into running shoes and top and I was off on the last 3.2 miles. Now the weather was a good deal warmer, so no long sleeves were needed.
One of the things that the run (really an extended jog/walk) taught me was just how hard it is to do even a short triathlon like this one. I appreciate much more how hard an Ironman event must be, especially with diabetes. By the time I got to the first water stop, my blood sugar was dropping faster so I drank some energy drink and walked on. At some stage I passed the 1-mile marker and was very disappointed that it didn't have a big 3 on it!
But I made it all the way home to the big timer and a "Bernard Farrell is now a Mainiac" announcement from the DJ.
The organizers did a great job. There were several folks from a local college who were training as masseurs, so I managed to get some relief for my brick-like calf muscles. That helped a lot.
Total time was a big disappointment, a little over 2:07. But looking at the biking time, I realize that it was the tiring swim that really messed me up. During the entire triathlon my blood sugars ranged from 230 to 130, which is a little high but a great range overall.
The good news was that I finished the triathlon and was still able to walk/get around for the rest of the weekend. Along the way, thanks to many friends, I managed to raise over $4,700 to support Dr. Faustman's research into a type 1 cure. (And I'm happy to take more donations if you're feeling generous.
By a strange coincidence I met Dr. Faustman on Monday, when I was giving another blood sample for her research. The news there is all great. In August her team published a paper showing that their approach kills the bad T-cells that destroy our insulin-producing beta cells. They also showed that this approach did not kill any important cells in the healthy blood samples. To my mind, that's important proof that this is unlikely to produce unwanted side effects.
Dr. Faustman also told me that she was interviewed recently and asked which venture capitalist was funding her research. She told the interviewer that it was being funded by lemonade stands and bike rides. He was amazed that this level of research could be funded in that way.
Those of us in the D-community understand the importance of this research for ourselves or our children. And we're doing whatever we can to keep it going, though it seems like an impossible task at times.
Thank you all for your support in my triathlon attempt. Next year (hah!) I plan to get to the finish line much more quickly and in better shape.
Attribution: The great photos were taken by my sister-in-law, Marie Mersereau.
While not directly related to diabetes, the New York Times posted an article Doctors and Patients Start Talking that points to a new series being written by an oncology doctor, Dr. Pauline Chen. She is the author of Final Exam: A Surgeon's Reflection on Mortality. I have not read the book, but there's a huge amount of discussion on her article at the NYT site.
Those of us with chronic illnesses understand the importance of good, honest communication with our healthcare team. Some doctors and nurses aren't good at that, others don't have time to really explain things or answer questions. So we turn to help from folks on TuDiabetes.com and other supportive sites. I think this is part of how healthcare is evolving in the US. What do you think? Maybe you can leave a comment on the NYT site.
While I'm talking about reading, here's a free book that may be really useful if you're dealing with the US healthcare system. I just started reading My Healthcare is Killing Me! earlier today and I've already got some ideas for better handling myself within our (sometimes challenging) system.
Finally, if you're one of many of us who'd like to see insurance coverage for CGM devices, please go and sign Gina Capone's petition. If you'd like to know more about Gina and the petition, read Amy's interview with her.
The New England Journal of Medicine has just published a paper on a JDRF-funded study showing how continuous glucose monitors impacted blood glucose control.
The study proved that CGM's resulted in better blood sugar control for people over 25. Hopefully this paper will be useful in supporting insurance claims for coverage of CGM devices. Maybe you'd like to send a copy(PDF) to your insurance company when you make a claim for CGM coverage.
I'm excited that this independent study of a relatively large number of people showed such good results. A few more like this, and it will be hard for companies to argue that CGM's are experimental devices. Dexcom summarized the paper like this:
Highlights of the study results include: -- Patients 25 years of age or older who used CGM showed significant improvement in glucose control as measured by HbA1c. -- Most importantly, this improvement in control was observed without an increase in hypoglycemia (low blood sugar), which is a common concern in intensively managed patients trying to achieve improved glucose control. -- In all ages, patients who used CGM at least six days a week had substantially improved HbA1c levels.
In addition to successfully meeting statistical significance for the primary endpoint of absolute A1c reduction, the adult cohort in the study – patients 25 to 72 years old – also successfully met all secondary endpoints with statistical significance (including A1c of less than 7.0 percent, A1c of less than 7.0 percent with no severe hypoglycemia, greater than 10.0 percent relative reduction in A1c and greater than 0.5 percent absolute reduction in A1c).
Younger patient populations did not see a statistically significant reduction in A1c. However, patients in those study arms used the Personal CGM device less often than prescribed (50 percent of the time or less). All patients, regardless of their age, experienced A1c reductions when they used the device at least six days a week. The most compliant study arm – adults 25 to 72 years old – used the device more than 85 percent of the time and subsequently saw the greatest improvement in A1c. These findings expand upon the results of previous studies – like the Star 1 Study – demonstrating that more consistent use of Personal CGM results in more significant reductions in A1c.
As I prepare for my fund-raising triathlon, I've been doing a lot of swimming. One problem that I had to solve was how to swim and monitor my blood sugar at the same time.
My Dexcom receiver has to be within 5 feet of the sensor/transmitter. That doesn't work when I'm swimming 1/4 or 1/2 mile distances. While the sensor/transmitter is waterproof, the receiver isn't.
I read somewhere about Aquapac and it's line of waterproof cases, so I measured my Dexcom receiver and ordered their mini class case.
When it arrived it certainly looked big enough for the Dexcom receiver. But when I tried to put the Dexcom into the case, the face would bind to the plastic. So I took a small index card, folded it, and slipped it into the case first. Then I could easily get the Dexcom receiver in place. I use the index card again when I want to get the receiver back out.
When I'm swimming, I use the cord that comes with the Aquapac. I can swim with the cord around my neck, and provided I keep it on the same side as the sensor, I get great readings during the swim. I can also see the values while I'm in the water.
For my triathlon, I leave it in the case until the end. That way I don't have to worry about damaging the receiver due to sweat or rain. I've used this case on three long swims (> 15 minutes in the water) and it's worked perfectly.
She mentions an additional benefit to the Phase 1 trial. Besides validating that BCG has some effect on the bad T-cells that are killing insulin-producing beta cells, it validates that the various new blood tests that they have developed to track the bad T-cells.
She comments on the recent research showing that pancreatic cells can be transformed into islet cells. There's a lot covered in this 12-minute interview, it's worth listening to.
David Edelman's great video interview with Dr. Denise Faustman is now online. It's about 47 minutes long and well worth watching.
I was in the room when this interview took place - David and Elizabeth were generous enough to share this opportunity with me.
The interview provides a wonderful insight into Dr. Faustman's research and her thinking about a type 1 diabetes cure. They've also provided a transcript. (PDF)
If you'd like to support her research, it's not too late to support my triathlon for a cure. Or just go directly to the Mass General site and donate there.
The Diabetes Technology Blog is focused on using technology to life better with diabetes. I review: blood glucose monitors; continuous glucose monitor; blood sugar meters; diabetes software and living with diabetes.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.
