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I need help writting a letter for the CGMS

Discussion in 'Parents of Children with Type 1' started by lotsoftots, Feb 13, 2009.

  1. lotsoftots

    lotsoftots Approved members

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    OMG I call the ADA and got his man on the phone today he sounded like Rocy and I swear he was a dumb or a rock!!!!! I asked him what was best type of info a Dr would need to write to the insurance company to get the CGMS approved..he started telling me to go to C.V.S:confused: and have them check into the prices of test strips and I didnt have to use an inhouse meter..WHAT so I stopped him and again told him it was for the CGMS and even told him what it was and what it did, he then started telling me the name brands of them and who makes them...again WHAT I told him more then once the pump she had and which CGMS I wanted to go with the out of the blue he told me well we have papers on how to go about a denial form..this man was a trip..
    So my problem is when we went to the endo yesterday he said yes you can have the CGMS but I will not written any letters its not worth his time since no insurance company will cover it..sigh..so my reg Dr said he would write this letter but needed to know what I want in this letter..so I need help what types of things so do we need
    !) she has had a few unaware hypo's
    2) her last A1C was 7.5 this one was 8.7 :(
    3) we have highs of 300 to 400 out of no where no pattern..
    4) puberty is just around the corner..yikes
     
  2. Omo2three

    Omo2three Approved members

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    Maybe he was hypoglycemic... its frustrating trying to get info!

    I am interested in this too, I got the same reply from my endo.

    Did you get your regular pediatrician to write the letter of recommendation?
     
  3. lotsoftots

    lotsoftots Approved members

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    Im going to see him today..so I need to know what to tell him to write...right now Im calling minimed to see if they can help me any
     
  4. vettechmomof2

    vettechmomof2 Approved members

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    Call the sensor companies and have them talk to the doc. They have prewritten froms they could even give to the doc.
    Good luck,
    Allene
     
  5. lotsoftots

    lotsoftots Approved members

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    wow I just talked to one of the supervisor at Minimed and OMG did he ever help he told me just what the dr needs to write what was the best info to insert everything..told me to have the Dr call him if he has any questions and he is now handling our case:D if there is a denial he will go through that process with us too...I feel better, like for a change someone is willing to help...the rep I m suppose to work with.....well I m too nice to say how I feel about her here:p
     
  6. Shirley and Jamie V.

    Shirley and Jamie V. Approved members

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    Debbie:

    I am sitting here with my insurance denial letter in hand. I wanted to ask if there was a site that refuted the "investigational" status of the CGMS. Do you know where that can be found?

    I can start a new thread myself if you don't.

    Thanks and keep me informed.

    SHirley
     
  7. MReinhardt

    MReinhardt Approved members

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    The reason why I like MM. They have been there with Chell for 2 years now. 100% of the way.
     
  8. Shirley and Jamie V.

    Shirley and Jamie V. Approved members

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    I just posted this on my thread.

    ADA just sent me the following:
    Here is a link to a study published in the New England Journal of Medicine that shows that CGM has clinical data that improves outcomes. In addition, Maggie's doctor can resubmit with a letter of medical necessity. This is where it should say why she needs it - here are some of the "buzz phrases" that have been able to get the device approved for other patients:

    www.eurekalert.org/pub_releases/2008-09/jdrf-jfc090808.php

    Here is also a link to a blogger who is also trying to get the CGM covered - she uses some good arguments in here... some additional ideas.

    http://sixuntilme.com/blog2/2008/09/cgm_study_shows_this_stuff_wor.html

    1. hypogycemic unawareness "Maggie doesn't always feel her lows and this device will help avoid potential deadly consequences" **This one seems to work the best especially for a child**

    "We are applying for the CGM because Maggie's body does not recognize the symptoms of low blood sugar with any reliability"

    2. A1c out of range - if it is out of the recommended range (even if it is 7.5 ADA's range is 7.0 and uder) - you can say that the CGM will help get better control and avoid the potential outcomes and side effects

    3. Large fluctuations during day - "dawn phenomenon"

    Anything that is out of the norm - (even if you are taking good care of yourself) - that will help get this approved.

    Good luck,

    Shirley
     
  9. lotsoftots

    lotsoftots Approved members

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    Thanks for the info!!!
    this is some of the things the Minimed guy told me..

    1) unable to stabilize blood glucose

    2) having hypogycemic unawareness down in the 40's with wide flucatuations up to the high 400 and 500's

    3) recenlty started showing ketones for over a week, while showing ketones lab work was ran, all test came back normal

    4) having lows at school which is unsafe for the child

    5) recent A1C went up from 7.5 to now 8.7

    then he said to have the Dr also write something like this

    *** I am prescribing the continous gluose monitoring system to get tighter and better control of Samanthas glucose readings****

    oh and to send them the last few months of her logs and all the lab work to Minimed..

    My Dr said he will have the letter written by the end of next week and that he was sory it was going to take so long but he is goingon vacation after tomorrow...:)

    I guess we will wait and see at least someone is trying to do something for a change...lol
     

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