Allies Voice: The CGMS Conundrum - Why the heck NOT?
I'm fuming!! I know…. What's new, right? Seriously this time I'm heated about nonsensical insurance company denials of continuous glucose monitoring systems.
There's no question (or is there?) that glucose monitoring and diabetes go hand-in-hand. This may sound terribly naïve, but why is it insurance companies are denying requests for people with diabetes to get continuous glucose monitoring systems (CGMS)?
Yes, glucose monitoring is vitally important when it comes to diabetes control . I use the term "control" loosely because it's almost guaranteed Murphy's Law. However, the campaigns that have been running like Forrest Gump since the completion of the DCCT - blood sugar control to prevent diabetes complications - are beginning to raise eyebrows.
If insurance companies are denying requests for patients to have top notch devices to ensure ultimate glucose control - are they inadvertently saying it's NOT that important? Because at the end of the day, when the complications come calling the insurance companies are the suckers footing the bill. Maybe they're just hoping it's not on their tab by that day.
Either way you slice it - the business of diabetes (diabusiness) is getting out of control. Costs of medicines are skyrocketing. Insurance companies are denying requests willy nilly. And the patient quality of life is suffering the consequences. What is a person to do?
Let me introduce the ONE GIRL putting her rejection letter where her mouth (or websitesite) is. Her name is Gina Capone and she's the better half (just kidding Johhn) of the amazing website, Diabetes Talkfest. Gina has drfted a petition for people who have also received the dreaded denial letter. She invites people to voice their displeasure with the disconnect and complete misunderstanding insurance companies express when they deny funding to people with diabetes for a CGMS.
As word of this CGMS cold shoulder gets 'round - the writing on the wall will become more apparent. Where is diabusiness headed?
To stick your e-signature on this petition visit Diabetes Talkfest at: http://www.ipetitions.com/petition/CGMSdenial/
Allie—
The first question we should all ask ourselves is, “Where are our caregivers and our charitable advocates, who should be proclaiming to our politicians and the world this is the “right thing to do.” The only thing the insurance companies are waiting for is for the government to step up, state-by-state, and through federal programs, to subsidize the approval of this continuous glucose monitoring system. That means everyone who buys insurance in the U.S. will pay an approved increase in premiums in order to subsidize the diabetic population. A little play on words, but that is the ‘right thing to do’ because Republicans are always looking for ways to extract money from the general population to benefit the insurance companies (and other corporations) and provide that ‘feel-good’ image of helping the disadvantaged (diabetic population).
When there is already technology that would provide continuous bG monitoring, and cost less per year than the average meter (with strips) costs, it doesn’t take long to figure out what is wrong with this total picture. Certain large groups of pharmaceutical diabusiness, the insurance industry and the FDA have gotten together to put the squeeze on 300,000,000 people to pay more for less. Meanwhile, a cost-effective, reliable monitor is languishing in some dark hole at the FDA while they debate the “dangers” (accuracy) of a non-invasive monitor. It seems the FDA does a heck of a job protecting entrenched corporate interests.
Reply to this
It's all about the money for insurance companies and they don't care if your blood sugar is good or not if you are a diabetic they don't want you. My insurance company made over 1 million dollars in profit from a company that I work for by providing health care tips and offering a HMO and telling people to take care of themselves so they don't have to pay any claims. Being a diabetic is a huge claim cost for them. They tried to tell me that a cheaper form of insulin was available and they did not want to pay for my natural insulin. I wrote an appeal to them that said that I would be contacting my congressman and other agencies to fight this rejection and threaten them with a possible law suit and other options. Needless to say they paid. IT IS TIME TO FIGHT and not play nice guy anymore with your doctors, insurance companies, your employer, or anyone else who gets in your way of living a half way decent life with this condition. Everyone has to contact anyone and everyone to let them know not to take this crap anymore from anyone who tries to tell you how to live with diabetes. It's the money people and as soon as you figure that out you will be one step ahead. The next thing to do is get nasty and fight back with all of them because in the long run you are right and they are wrong. Good Night and Good Luck. No one is on your side with this issue so it does not matter anymore just respond in any way necessary to take care of your self.
Reply to this
You are so right about this and have said what I have been feeling for a long time, especially after coming across those very same people in Healthcare.
Reply to this
The simple fact is that by denying coverage, the odds FAVOR the insurance companies. Remember, the patient is not their customer, but the companies whom they sell policies to. Chances are high that you will change carriers numerous times over the years for many reasons: new jobs, employer decisions, etc. The question they are answering is whether you're likely to get complications under their coverage? The odds suggest NOT ... far more likely that social security will be picking that tab up, which is good for shareholders very well!!
Reply to this
Since health insurance companies make money by careful study of epidemiological statistics, I suspect that if they really believed that improved blood sugar control would make a cost-effective difference in the health outcomes of diabetic patients whom they are already obligated to cover, they would offer coverage for continuous blood glucose monitors. After all, they offer reductions in the cost of property insurance for buildings that are closer to fire hydrants or that install fire detectors, so why would they adopt a different attitude with respect to diabetics?
Part of the reason may be due to the different view of the DCCT by the medical profession and the insurance business. While the DCCT showed a general link between lower complications and better glucose control, earlier studies put the DCCT in context by showing that a much more important determinant of outcomes for diabetics is the patient's theoretical ability to control glucose by injecting less than 0.5 u/kg/day of insulin, regardless of the actual degree of control achieved. The reason for this is probably because those patients who can get by on a lower daily insulin dose are those who are experiencing a weaker form of autoimmune attack, so that some of their beta cells have survived the initial onslaught, or so that their beta cells have a chance to grow back a bit despite the continuing autoimmune attack. But if this is the case, then the real cause of the complications is the strength of the autoimmunity, not the level of blood sugar control, which is only correlated with better outcomes the way the column of mercury in a thermometer is correlated with the patient's temperature. It is a measure of the problem, not the cause of it, so controlling the measure better will not improve the outcome.
Reply to this