From time to time I'm reminded about just how devastating diabetes might be. In this case I'm not thinking of the various complications that we think about all the time. This is a situation that those of us in the US are more in danger of encountering
Until yesterday, I thought that personal bankruptcy was really reserved for those of us without insurance. But the article Insured, but Bankrupted by Health Crises in yesterday's New York Times points out that being insured doesn't mean I'll be saved from financial woes. Hearing that "an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured" does not make it easy to sleep at night.
For me living with diabetes is all about balance, nothing new about this if you've been living with diabetes at all. But here's a situation that I just can't balance out.
Since being laid off earlier in the year my insurance is provided thanks to COBRA. But that will expire in the middle of next year and my insurance choices at that stage may be severely limited. With an 'existing condition' my chances of getting coverage for diabetes costs are zero unless I have a full-time job with health insurance by then.
But here's something that I may be able to affect positively. I'm going to write to my federal representatives and let them know just how important health insurance legislation is for me and my family. Not being covered is a challenge for me that strains our budget. But declaring bankruptcy affects my family and I don't like it when something threatens people I love.
Can I ask for your help?
I know from years of contacting elected officials that a note in the mail is often the most effective way to get their attention. A hand-written note really wakes them up, but even a typed letter goes a long way. Look up your elected federal officials and drop them a quick note telling them why access to real insurance is so important to you. If they hear from a handful of us it might just make the difference when it counts most.
In the last week I've read two different sources on social networking (AKA health 2.0). Together they beg the question: will your health improve if you use social networking to become part of a larger community?
What is social networking?
According to the Health 2.0 blog, it's "the use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health".
The first source was an article in Business Week magazine Health 2.0: Patients as Partners talks mostly about PatientsLikeMe and how members there are sharing details on their medical conditions to try and determine better ways of treating them. It points out
PatientsLikeMe and a proliferation of similar startups are building a new business predicated on the belief that the wisdom of crowds of patients will bring insights, solace, and most of all, power.
Power because, as it turns out, patients talking among themselves on a global scale with complete transparency produces all kinds of unexpected results. Drug side effects can be reported to regulators by the patients experiencing them, without waiting for the manufacturers to come forward. Pharmaceutical companies can use social networks to recruit subjects quickly for clinical trials, speeding up the pace of research. For that matter, patients can simply band together and run their own clinical trials, leaving drug companies and physicians out of the loop.
Do social networks bring about positive behavioral change?
Is there a role for insurance companies in this conversation, or is this level of mis-trust so high that they should just stay out?
My experience after many years with diabetes is that anytime several people get together to share experiences and frustrations we all benefit from it.
These may be small things, like suggestions for exercising while on insulin, or using new sites for placing an insulin pump infusion set, or testing blood sugar.
But engaging with others who are going through the same health challenges can produce much bigger results like: persuading Disney to pull an episode of Hannah Montana because of how it portrays life with diabetes; or changing laws to help protect the rights of those using insulin to drive or pilot planes.
What's your experience with social networking sites?
Have they helped you improve your diabetes control, or your quality of life with diabetes? Which sites have helped you the most? What is missing from these sites?
And if you have found some that work for you, do you think you'll continue to use them?
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?
I was reading Forbes magazine this evening and noticed a full right-page advertisement that started with this statement.
3rd Law of Healthonomics Soaring healthcare costs are only the symptoms. You've got to start treating the disease.
The remainder of the advertisement reads.
Most employers are rethinking their responses to escalating healthcare costs. Why? They recognize chronic diseases are the root problem. Example: An employee managing his diabetes might cost $5,000 per year. An employee not managing his diabetes could cost up to $45,000. The win-win here is that by providing employees incentives to lead healthier lives an helping them to manage their chronic diseases, you reduce your healthcare costs. And you'll have healthier employees. Sure beaths the alternative.
The DTCC FAQ page includes the following summary of how the DTCC works:
The Diabetes Ten City Challenge establishes a voluntary health benefit for employees, dependents and retirees with diabetes, provides incentives through waived co-pays for diabetes medications and supplies, and helps people manage their diabetes with help from a pharmacist coach in collaboration with their physicians and diabetes educators.
I like the idea of waiving co-pays for meds and supplies to help with better diabetes management. I just wonder whether this program is aimed at people with all forms of diabetes, or just those with type 2? Given that one of the sponsors is GlaxoSmithKline, I'll bet I'm right. Will is lead to better benefits for insulin pumps and continuous glucose monitors, or will the focus on cost reduction mean these important technologies are less covered?
This program is being tried by a number of employers in the following cities: Charleston/Spartanburg; Cumberland; Chicago; Colorado Springs; Dalton; Honolulu; Los Angeles; Milwaukee; Pittsburgh; and Tampa Bay.
Have you been enrolled in this program and can you give any feedback on how it works for you? I'm interested in seeing if this is the start of a new approach to diabetes care across the country. And I'd love to know whether or not it includes all types of diabetes.
to be the resource on the web for anything about CGMS reimbursement.
And on Monday the Centers for Medicare & Medicaid Services (CMS) finally approved billing codes for continuous glucose monitor systems.
In theory this means it will become a little easier to claim for these systems from your insurance company. In reality, it's not such a slam dunk. Until there is more proof that use of a continuous glucose monitor improves blood sugar control, insurance companies are not going to cover these devices as a matter of course.
While we're waiting for better coverage, if you've got any information about insurance coverage for CGMS based on your experience, do visit CGMS Central and share the information with others.
This short and readable document includes the following sections:
Key Findings about CGM Users
How Patients Use CGM Systems
Comparison between Minimed and Dexcom
Why Patients Stop Using CGM systems
Some thoughts on Reimbursement
I think you'll find this a useful document and well worth the read.
On a personal note, I'm about to start the reimbursement process for my Dexcom 7 STS with my insurer this week. Can I tell you how much I'm not looking forward to this? Why is this so hard?
Given that my A1C went from 8.2% to 7.% while I was using my Dexcom STS without hardly any significant lows it should be clear this system is beneficial and reduces costs in the long term. I just hate having to argue this all with many levels of insurance bureaucracy. I'll let you know how that goes also.
On Tuesday the Wall Street Journal had a very interesting article on cutting copays(preview only). It's worth looking for it in your local library.
Apparently some employers and health care companies are trying to reduce the long-term costs for those with chronic diseases. And now they believe that if they provide the necessary drugs for maintenance of those diseases with zero copay amounts, then folks might actually take the medicine.
Well duh. I guess that's why the executives of these companies get the big bucks.
According to the Journal "employers and health plans have targeted conditions like diabetes and heart disease in part because chronic illnesses are major drivers of the over rise in health-care costs". The emphasis on diabetes is mine.
Now my guess is that they're really talking about Type 2 diabetes. Of course I still hold out hope that they'll do the same for Type 1 diabetes and actually cover the technology that we need to maintain our blood glucose levels and reduce long-term complications.
Let's call this article a glimmer of light at the end of the tunnel.
Codes for insurance coverage of Dexcom devices may be issued later this year.
According to this Forbes article, there will be a public hearing in May and the codes may be available before the end of the year.
I'm hoping that this means insurance companies will actually get a bit more flexible before final approval.
Dexcom shares have increased significantly as a result of this. I wonder if folks were just using it as a chance to cash out. Let's see what happens to the share price over the next few weeks. That'll indicate what the market really thinks about Dexcom and its future prospects.
The Diabetes Technology Blog is focused on using technology to live life to the full with diabetes. I review new diabetes technology including: blood glucose monitors; continuous glucose monitors; blood sugar meters; diabetes software and living with diabetes.
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 Plus CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.