- advertisement -

I want a CGM for my youngest.

Discussion in 'Parents of Children with Type 1' started by mmgirls, Mar 24, 2014.

  1. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    But most likely I can' t get it covered by my new insurance.

    She is so newly diagnosed, no Official endo visits, nor BG meter logs. These are things that my new insurance requires for DME coverage.

    I didn't know the good thing we had with Dexcom being covered under Rx, where none of that is needed.

    I am down right tired, and heartbroken that I may resort to doing what I feel I need to do without going thru the proper channels.

    It is so stupid, really and Truely, I would rather do a few finger sticks a day for my kiddo that is not yet taking insulin and see whatn her trends are .

    But no, the geniuses out there believe that it is more acceptable to test before and after each meal to just gather data to prove that insulin is needed.

    She did not respond to antibiotics for an ear infection and we are now on a stronger round to now combat a sinus infection. And I am worried that this might just be the straw that breaks her pancreas fir good.

    We are honestly doing good with the second diagnosis, yet not well with getting what we think we need to make the transition of caring for 2.
     
  2. Kunkfam

    Kunkfam Approved members

    Joined:
    May 12, 2009
    Messages:
    125
    Your dr may be able to pull it off! We got one for my daughter almost immediately following her diagnosis. I'm not sure how they did it but they did. It may be worth a shot! Or I would just do it through pharmacy like you said. When they did her pump soon after omnipod sent her info to Solara and they filled that through pharmacy so they didn't have to wait for ins approval. They waved our copay as well.
     
  3. mamattorney

    mamattorney Approved members

    Joined:
    Apr 9, 2013
    Messages:
    1,076
    I say, go ahead and try. As far as I know, insurance companies are not prejudicial in that if you ask for something and are denied, you don't get a fair review the next time you ask. I think they look at each submission as it's own request independent of what happened in the past. If I'm wrong, someone please correct me.

    But, what's the worst they can say - No? You don't have one now, so there's no downside for you.

    I looked at our insurer's medical policy and mine says that a requirement is "compliant with 4 or more fingersticks a day and three or more insulin injections per day", so I don't know if my insurance would cover it either -- however, there were many requirements that seemed cut and dry for getting my daughter an insulin pump, that they didn't require - she was supposed to wait 6 months, send in logs, etc. We didn't do any of that. So, sometimes the medical policies don't tell the whole story.

    As long as you can get your doctor onboard, I'd absolutely try for it.
     
  4. Cheetah-cub

    Cheetah-cub Approved members

    Joined:
    Feb 18, 2014
    Messages:
    241
    I just started the process for a CGM for my daughter last week. I spoke with the Dexcom rep, and yes, they did send me a log sheet, and told me to fill it out. They needed 30 consecutive days worth of logs, and the data must be within 90 days. They said the insurance required blood sugar checks 4 times a day, and must show 4 readings below BG 50 during this 30 days period.

    I did fill out this sheet for them, and send in all our insurance information. The Dexcom people will contact our doctor and submit everything to our insurance on our behalf. We hope to get approved soon.

    However, there is got to be exceptions to the rule. Your family isn't new to T1D management. I too think you can contact your doctor and convince the insurance to approve a CGM for your daughter sooner rather than later.
     
  5. twintype1s

    twintype1s Approved members

    Joined:
    Jun 4, 2010
    Messages:
    99
    Agree with everyone else...if your doctor is on board, you may be able to get it through. Not exactly the same thing, but I was able to get Nate's insulin pump approved weeks before he actually required insulin, so when he did need insulin, he went straight on the pump.
     
  6. Cheetah-cub

    Cheetah-cub Approved members

    Joined:
    Feb 18, 2014
    Messages:
    241
    I just heard from Dexcom that our CGM is ready to ship!! That was super fast. I just emailed them my 30 day BG log on Friday.

    We have Blue Shield of CA. So far, I am pretty impressed with our insurance company. When we applied for an Onmipod, we were told to be prepared to be rejected, because my 10-year-old was diagnosed only 3 months prior. My husband and I were prepared to battle our insurance company, but it was quickly approved. I also expected some degree of difficulty with getting a Dexcom, but it was approved super fast.

    You should contact Dexcom and initiate the process, and hopefully you will get one fast too. Good luck!!
     
  7. MEVsmom

    MEVsmom Approved members

    Joined:
    Aug 2, 2013
    Messages:
    255
    I didn't even have to submit any logs for Dexcom. We were less than 3 months past diagnosis. I called the rep on Friday. I scanned him the paperwork within the hour and the Dexcome came UPS the following Tuesday so I would imagine it would depend on your particular policy. Now, My doctors office had some logs and maybe they provided them to Dexcom/Insurance, but if they did, I didn't know about it.
     
  8. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    If we had pharmacy it would have been like that, but under medical our insurance has required documentation which we do not have yet.
     
  9. MomofSweetOne

    MomofSweetOne Approved members

    Joined:
    Aug 28, 2011
    Messages:
    2,743
    Your case is so unique with your daughter being diagnosed so early through Trial-Net. It would seem that your doctor should be able to make an appeal that seeing trends would allow you to better know when and how much insulin to dose and that a CGM system would be much cheaper than the typical hospitalization at diagnosis.
     
  10. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I hope so. Just waiting for all the paperwork to get over to the endo from Trial Net, of course there is a conference this week that most of Stanford it seems went to.

    I have a call into the endo asking their position on using McKenna's system on Madison, I think they will be favorable to the idea if we can not get insurance approval. Because it would at least know when I should test to have a BG meter show the extremes of BG. I wonder if her BG goes up an hour after she falls asleep like sister?
     
  11. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I hope so. We are running McKennas thru first to see what they really require compared to the published information.
     
  12. sincity2003

    sincity2003 Approved members

    Joined:
    Jun 1, 2013
    Messages:
    315
    I don't remember what insurance you have, sorry, but from reading here, and from my own experience with getting 2 pumps approved within 60 days of each other, Blue Cross and its different variances seem to be the most lenient when it comes to approving devices for Type 1 children. To get our Dexcom, I filled out a paper at the endos office and they sent it off. I wasn't asked to provide anything else, so I don't know if they sent in the logs or not. Also, when we got the Animas pump approved 60 days after the OmniPod was approved and paid for, they requested his logs just to show that his BGs increased while on the pod, but didn't request any other documentation.
    I think a strong letter from an endo (usually written by the CDEs, but signed by the endo, I've learned), does wonders to sway an insurance company. And, like another poster said, make sure they mention in there that if you are monitoring her through a CGM, they are going to save thousands over a hospital admission if she ends up in DKA.
     
  13. rgcainmd

    rgcainmd Approved members

    Joined:
    Feb 6, 2014
    Messages:
    1,371
    mmgirls, I agree with you: the whole insurance thing is stupid and sucks. As a physician, I have had more than my fill of insurance companies dictating what I can and can't prescribe for my patients. When I complain, I am told "Dr., we wouldn't dream of telling you what to prescribe. Go ahead and prescribe whatever you want; we can't stop your patients from going to the pharmacy and filling their prescriptions." Knowing full and well that if they do not cover the cost of the medication (minus the patient's ever-increasing copay/deductible) there's no way anyone but the wealthy could afford the out-of-pocket expense. I can sometimes get around this via the dreaded Prior Authorization song and dance. Perhaps your endo can perform the DME equivalent of a Prior Authorization... If this fails, I've been known to contact a company rep and beg for a favor. Good luck and I hope you can work this out. Why this type of issue seems to always fall on those most in need during times of higher stress, I'll never understand...
     
    Last edited: Mar 25, 2014
  14. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I am working it, but the problem I am running into trying to get anything from Dexcom is that the G4 has not been approved by the FDA for trials in patients, let alone children. I am waiting for the Dr from Trial Net to get back form the conference and will be asking if funding can be found a study started or found that a 5year old can participate in. I'd be willing to borrow a sytem for now!
     
  15. sszyszkiewicz

    sszyszkiewicz Approved members

    Joined:
    Dec 24, 2013
    Messages:
    842
    Why do they consider it a study? She is diagnosed.
     
  16. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    If I can not get her a Dexcom because she does not meet the requirements, then I would look for alternate means of having her CGM full time. I have looked for clinical studies on the Dexcom but they have either stopped enrollment or she is too young, but it does not mean that there isn't one out there that I have not found.

    Everyone that I have spoken to would love to have the data, so I am hoping that it may be possible that someone has some funding they can throw at a Dexcom.
     
  17. dpr

    dpr Approved members

    Joined:
    Dec 17, 2013
    Messages:
    399
    Here's a thought, purchase 1 or 2 sensors from Dexcom and then use your older daughters system. That way they can't be upset about paying for sensors not being used on the child it was prescribed for. Then you'll have a few weeks or more of data that might help sway them. Keep a log of all the highs and lows from your older daughter while she is not using her CGM to show continued need for it. I'd run it by your endo first to make sure it doesn't mess up anything insurance wise for either or both girls. I'm so sorry you have to go trough all this.
     
  18. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    Do you know what the cash price for a box of 4 sensors is? $349.00

    They have a money back guarantee for 30days but that cash price is $1547 for the system and 1 month supply.

    The fact is that I have an extra transmitter that is still working but probably not for long its almost a year old and we have enough sensors to last us till we get them replenished for my older child.

    My thing is that I do not want to start her on the CGM if I will not be able to keep her on it because we need insurance to cover the ongoing costs, we can not afford cash prices.
     
  19. MomofSweetOne

    MomofSweetOne Approved members

    Joined:
    Aug 28, 2011
    Messages:
    2,743
    Would an argument that CGM would reduce the number of required test strips in a newly diagnosed-not yet on insulin T1 and yet give even better information about when the time to begin to use insulin is to avoid DKA help, do you think? They're going to end up covering the system anyway, and the cost per sensor would be small compared to gaining the same info via blood testing.
     
  20. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I hope so.

    But I am not sure how that all works because test strips are under pharmacy and CGM under medical/DME. Right now just trying to get the Dexcom thru our insurance for my older one so I have some real $ numbers to show.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice