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CGM and Kaiser Insurance

Discussion in 'Parents of Children with Type 1' started by Mommy For Life, Oct 11, 2012.

  1. Mommy For Life

    Mommy For Life Approved members

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    I was curious if anyone has had their Kaiser insurance approve a dexcom cgm? I've discussed a cgm a few times with our endo team, but didn't get the green light that they would give DD one. The endo said they would give us one if we were having problems with lows at night that we could not control. I was floored when our nurse said in front of DD that the CGM hurts :eek:. Any suggestions on how to get Kaiser to prescribe a CGM without having to "trick" the meter"? :rolleyes:
     
  2. Dad of Daughters

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    If it were me, I'd be endo shopping before I went CGM shopping. It's not uncommon to have to "sell" the insurance company on your desire to use this tool, but you shouldn't have to be selling the endo. Remember, they work for you, not the other way around.
     
  3. Mommy For Life

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    I totally agree, but my husband's job uses Kaiser and it is what we have. I might just have to push them to give us a prescription. I am not even sure if I can get DD to wear the device after hearing they hurt. UGH!
    thanks for the reply.
     
  4. MomofSweetOne

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    Supposedly the new G4 sensor hurts less than a pen needle. Your nurse needs some updated education on CGM technology and its benefits!
     
  5. selketine

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    We have Kaiser Mid-Atlantic and they've approved and paid for the Navigator that we got several years ago and then the Dexcom once the Nav went out of business. Our pedi endo had no problems writing a script for it.

    Dexcom holds classes on how to use their cgms at some of the California Kaiser locations. I'm fairly sure that the Kaisers out there will approve it. http://www.dexcom.com/customer-care/live-classes

    I agree that if the pedi endo stinks then you should look for another one - within Kaiser would be easiest. We've had Kaiser for a long time now and they have been wonderful with everything we've asked for and needed.

    You need to also call Dexcom and talk to them. They should know if the Kaisers out there routinely write scripts for Dexcoms.
     
    Last edited: Oct 12, 2012
  6. Jaredsmom

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    My son says his Dexcom insertion doesn't hurt any more than the pod insertions and they don't hurt as much as the lantus did hey says. Our endo had us do a one week trial with the Dexcom prior to writing the rx they let us chose which Cmgs we wanted to trial they had the minimed and the Dexcom she said the Dexcom hurts less and she has used both.
     
  7. Ndiggs

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    Our daughter stated using her dex when when she was 3, she is now 5 and honestly does not notice the sensor unless it gets hit directly (ie like with a ball on the playground at recess the other day) We put the sensor on the back of her arm, and pinch the skin up as we insert it, I have replaced a failed sensor in her sleep and she has not woken up so I am pettry sure it does not bother her too much. She does say ouch, but it is usually before the insertion process starts when I pinch up skin, so I think its more that she is messing with me :D
     
  8. anna-bananna

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    You are braver than me! I would be so afraid that tricking the meter would backfire on me/my child when I try to explain my dosing decisions to the D-team!

    But, anyway, I'm not sure it would help. We have Kaiser in the Pacific Northwest. DD has a history of random, sudden lows at night, and her team doesn't know how to advise me, other than to give her a bedtime snack (which doesn't work for us...all it does is spike DD into the 300's [no matter how small the snack], and I don't feel comfortable with having her in the 300s every night, just to keep her from going low.) She also has lows (down into the 40s) that she is not feeling during the day. (Sometimes she feels it, sometimes, not.) Her team still does not see the need for a CGM. They think I need to test less and stop worrying so much about the numbers! :eek::confused:

    I think people who do not have Kaiser (or who don't have Kaiser in certain areas) do not understand that you can't just get the "endo" (up here, they don't even have Ped. endos for diabetes...you see a diabetologist, which for us is a pediatrician with training in Diabetes care) to write you a prescription for what you want. Kaiser holds all the cards. You can only see Kaiser doctors and go to Kaiser pharmacies. The insurance part tells the doctors and pharmacies which types of care/prescriptions you are allowed to have (under what conditions) and that's all they are allowed to offer/prescribe/carry in the pharmacy for purchase, etc. So, if DD's team does not approve of her having something, then she isn't going to get it. Period. I wouldn't even know where to go to appeal. Member services is a joke. They have never actually resolved any of my issues. I think their job is to make you feel emotionally better, so you won't feel the need to go any higher. Then, when it doesn't get resolved, you realize that you don't know how to go any higher. (Although, I do plan to seriously research this.) They very rarely approve referals outside of their network (almost never), and most people cannot afford to go elsewhere, since you are treated, in that case, as if you are uninsured. In our case, there are two CDE's that work with all the Diabetes doctors, and they trade off and work together, and cover the entire region (service area) which covers two states. If you go outside your area, your insurance coverage is drastically reduced. So, we cannot even get a second opinion. Kaiser up here is great if all you need/want is very basic prescriptions/care, since they are cheaper than anyone else, and the D-team is really very emotionally supportive, and good with basic care/education. But beyond that, you are trapped into what Kaiser insurance wants for you and what they are willing to offer....take it or leave it. If you want power of choice, you have to pay for it...elsewhere! For us, we are a single income family and Kaiser is the only insurance DH's employer offers. So, we are doing our best within the confines we have been given until we can afford something else. :cwds:

    I just wanted to let others know that sometimes (especially if families have Kaiser in certain areas), then switching endos or insisting that "they work for you, not the other way around" in order to get the prescriptions you want, isn't always possible.

    Sad, but true. :(
     

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