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We got DENIED the CGMS

Discussion in 'Parents of Children with Type 1' started by momofphoenix, Mar 20, 2008.

  1. momofphoenix

    momofphoenix Approved members

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    Ok so tricare denied the CGMS for us. I have to start the appeals process this week. Can anyone help me in getting this started. I dont even know where to begin..... DAMN TRICARE!!!
     
  2. KitKat

    KitKat Approved members

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    I am so sorry. We are in the same boat right now with BCBS. Rick in the CGMS forum is really great about offering help. Good luck!
     
  3. zell828

    zell828 Approved members

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    I was reading a lot of good information under the CGM section here. Go under there and I am sure it will help.
     
  4. KitKat

    KitKat Approved members

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    I forgot to ask....why did they deny you? Ours was due to investigational/experimental. They must not be informed of their FDA approval status!!
     
  5. Lindy

    Lindy Approved members

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    Jessie - sorry to hear it! We are on our 2nd appeal with Tricare right now - don't know the verdict yet... but we are saying some prayers and keeping our fingers crossed!
     
  6. Abby-Dabby-Doo

    Abby-Dabby-Doo Approved members

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    You have to fight the reasoning they stated in the denial letter.
     
  7. momofphoenix

    momofphoenix Approved members

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    They stated that it hasnt been proven effective in the treatment of diabetes. They will cover it for preg. and that is it. They say it isnt any more effective then a fingerstick and that it isnt approved to replace fingersticks... I'm just so frustrated!!!!!
     
  8. Abby-Dabby-Doo

    Abby-Dabby-Doo Approved members

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    It's NOT to replace a fingerstick, it's for trends (alarms for highs and lows), or prevention of.
    Proven effective is through studies that have been done...



    I don't know if any of these studies will help you, but here is some of what I have. They may or may not be what your looking for. Our main purpose of obtaining the device is my daughter does NOT wake up for her night time lows.
    Hypoglycemia During Sleep Impairs Consolidation of Declarative Memory in Type 1 Diabetic and Healthy Humans- From ADA
    http://care.diabetesjournals.org/cgi...ract/30/8/2040

    Nocturnal hypoglycemia detected with the Continuous Glucose Monitoring System in pediatric patients with type 1 diabetes.

    http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

    [Decreased consciousness of hypoglycaemia and the incidence of severe hypoglycaemia in children and adolescents with diabetes type 1]

    http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

    Improvement in Glycemic Excursions With a Transcutaneous, Real-Time Continuous Glucose Sensor- from ADA

    http://care.diabetesjournals.org/cgi...t/full/29/1/44

    Awakening and Counterregulatory Response to Hypoglycemia During Early and Late Sleep

    http://diabetes.diabetesjournals.org...ract/56/7/1938

    Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus

    http://medicine.plosjournals.org/per...d.0040069&ct=1


    Use of Continuous Glucose Monitoring in the
    Detection and Prevention of Hypoglycemia

    http://www.journalofdst.org/January2...10-WOLPERT.pdf

    Impact of Real-Time Continuous Glucose
    Monitoring on Children and Their Families

    http://www.journalofdst.org/January2...YM9-WILSON.pdf

    Extended use of a new continuous glucose monitoring system with wireless data transmission in children with type 1 diabetes mellitus.

    http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

    Evaluation of CGMS during rapid blood glucose changes in patients with type 1 diabetes.

    http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

    Continuous subcutaneous glucose monitoring in children with type 1 diabetes mellitus: a single-blind, randomized, controlled trial.

    http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

    Subcutaneous glucose sensor values closely parallel blood glucose during insulin-induced hypoglycaemia.

    http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract


    Unrecognised hypoglycaemia in children and adolescents with type 1 diabetes using the continuous glucose monitoring system: prevalence and contributors.
     
  9. momofphoenix

    momofphoenix Approved members

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    Thanks for the links, I am going to have my hubby print them up at work today so I can fax them into the appeals office this afternoon..
    Thanks again.
     
  10. momofphoenix

    momofphoenix Approved members

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    Ok so I am working on my appeal letter to tricare. I know a few of you got denied from tricare also and ended up getting approved. Could you please pm me and let me know what worked for you??? I would appreciate it a great deal... thanks
     

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