19 January 2012

All Health Insurance Companies Need to Approve CGM's

     My type 1 diabetic child meets the criteria for coverage of a continuous blood glucose monitoring system, otherwise known as CGM. She experiences nocturnal hypoglycemia, or low blood sugar during sleep, several times a week. These do not wake her, contrary to the endocrinologist's reassurances to they definitely would. The only means of catching them is for me to get up every 3 hours and test her blood sugar. Part of the time, Miss N can sleep through those tests, but when she's low she has to wake up, drink and eat something, then wait ten / fifteen minutes to ensure her blood glucose level came up enough. 
     This isn't good for any of us, and her lowest lows tend to occur over night. If I don't get up, and sometimes I'm so short on sleep I wouldn't wake to a sonic boom, she could go low enough that she suffers seizures, or God forbid, death from severe hypoglycemia. So far, so good. I wake up most nights, and the nights I've managed to sleep through the cacophony that likely irritates my neighbors to the point of wishing we'd move (or worse), some profound 6th sense has woken me in time to catch a 40 on its way down. (Note, blood glucose truly should remain above 70!!) 
     As a result of this night time struggle, N now finds herself dealing with hypoglycemic unawareness - her body's inability to feel a low blood sugar,  fasting BG greater than 150, usually from treating night time lows,  but bad all the same. Nearly nightly, we see a drop of more than 100pt in blood glucose, so she has to go to bed in an unhealthy range if we want to avoid night time lows. For her overall and long term health, that is not a viable option. These all represent aspects of diabetes that pose serious risk to her health, from damage to blood vessels  and organs, to damage to her neurological system, etc. Untreated hypoglycemia ends in seizure or death, ergo the fear of sleeping through alarms, and yet our insurance continues to refuse coverage of a CGM. 
     In an effort to achieve better control, we're switching to an insulin pump, a device that continuously injects small amounts of insulin into her system. Of course, this makes us both much more nervous about night time blood glucose levels. I find it odd that an insurance company will cover, at least in part, an insulin pump but not continuous glucose monitoring. In fact, the pump N chose has an integrated CGM system, so her blood glucose values show up on the insulin pump, and the pump takes these trends into consideration when suggesting the amount of insulin to inject. So, seriously, it's a no brainer - you cover both devices simultaneously to prevent severe hypoglycemic episodes that lead to more costly interventions, hospitalizations, and at its worse, loss of life. 
     Of course, a number of insurance companies simply don't see it this way, nor do the employers that provide insurance through insurance providers more likely to cover CGM. I've shared before how I lost my teaching contract, and it still irks me to no end that I was informed, point blank, I faced non-renewal as a result of my child's illness, and the time I missed from work during her ICU stay. I know, logically speaking, that those involved in decisions regarding budget cuts, and contract non-renewals, faced enormously difficult decisions. In the effort to cut millions from the district budget, and further tighten  the insurance benefits provided teachers, they targeted staff  contending with their own chronic illness, or with chronically ill family members. Again, I get it. We pose a cost that employers both want and need to rid themselves of. Sadly, in education, they have the means to do so legally if you're in your first three years of teaching. Frankly, access to health care in our country sucks, but that's for another post. This is about CGM, and insurance covering a necessary and life saving device.  
     The truth is that criteria regarding coverage of CGM exists at a national / federal level. My child, along with countless others, qualifies for coverage of CGM according to that criteria. The trick, however, is that in the context of the documents outlining that criteria, three tiny letters appear, allowing state medicaid programs and insurance agencies to decide for themselves whether or not they cover CGMS. LCD - local coverage determination. Three letters, combined, that confer the power and ability of insurance companies and state medicaid programs to ignore the research, ignore standards of care recognized for the treatment of diabetes, and result in denial of CGM for many. This is a very important issue for ALL diabetics receiving insulin. So, I'm asking. Please join, and ask others to join, this important cause!

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