Last week, I started a blog entry:

An Internal Battle
 
Why do I want a CGMS? Right now, I'm not so sure. There have been numerous points in the last year where I've said how much better my quality of life would be if I had some more diabetes technology. There have been other points this year when I've said, you know I'm not sure my return on investment here is worth it.

I had intended to work on that entry over the weekend, but couldn’t find the words past this paragraph. One day last week I had really considered calling the medical-supply company I’m working with to get the DexCom to tell them to just forget it. And pretty quickly I decided not to, to allow myself to have access to the best technology to treat my disease. I decided to just let it go and see what happens.

This morning when I got into work, I stopped myself from calling the sales team at DexCom to see what they had heard from my insurance. Even though I really wanted to get this done before the end of the month since I had already met my deductible, I just didn’t feel the urge.

And then J from the supply company called.

“We heard back from your insurance company and they’ll cover the unit, the transmitter and the receiver,” she said.

“Well, great!”

“But they won’t cover the sensors because you don’t have disposable coverage,” she said.

“Disposable coverage?”

“Right, because the sensors are thrown away it’s under the disposable coverage.”

“Well that’s just…stupid,” I said. “It’s not like most of my pump supplies aren’t disposable and those are covered.”

“I know,” J said. “We’re working with insurance companies on this because the unit and transmitter and receiver don’t work without the sensors.”

Well, I thought to myself, this was the answer to my dilemma. I knew I couldn’t pay out of pocket for the sensors. I had already been to the online store to see how much all this would cost and I knew a box of 4 sensors (which should theoretically last for one month) was $240.

J still calculated my out of pocket costs ($396 per month if I try to submit to the insurance or $240 if I pay them cash; plus $175 for the transmitter and receiver since I would owe 20%). I told her I’d have to wait, and that I’d see if the insurance company had an appeals process. She understood, she said, and assured me she’d do the same.

It’s great that on one hand insurance companies are starting to cover the CGMS, but terrible that they’re still making it unattainable for some by throwing in a “disposable coverage” clause.