I don't think I've ever been more undecided about a health-care issue than I am right now.
To DexCom or not to DexCom?
Last week, I wrote that I was up in arms about my insurance company saying it wouldn't pay for the DexCom sensors because my policy doesn't have "disposable coverage" and that I was going to fight for the coverage. Today has been a pretty good day, and I've been thinking that I don't really need a CGMS.
I know, that's totally weird coming from someone who has been saying for months how beneficial the system would be to my life.
Late this afternoon my cell phone range. The caller ID showed "Nevada" and the only person I know in Nevada is S, my DexCom rep. It rang and rang while I debated whether to let it go to voice mail. Curiosity got to me and I answered.
After we small talked, S said he was calling because he had gotten a report from the medical supply company they work with saying my claim had essentially been denied. He had some information, he said, and something that might help.
Some policies with my insurance company haven't classified the sensors as durable medical equipment and the company is apparently working on getting the sensors worked in to being part of the approval process. That gave me hope, actually, because I am planning to appeal to the insurance company.
The thing he thought might help is to offer me my first box of sensors for free. If I went ahead and ordered the starter kit and had him send me the first box of sensors then I'd have a month's worth (or more) of sensors and possibly a leg up on an appeal: You've already paid for the machine but you won't pay for the piece that will allow me to use it.
That sounded good, but I didn't want to be left in a position where I've paid my 20% of the machine ($175) and then can't use it because the insurance company still won't pay for the sensors. I had planned to call my insurance company in the next day or two, I told S. And then he reminded me about my deductible and if I don't order the system before the end of the year I may wind up paying more for it next year than I would now (he is a salesman after all).
But do I want to risk wasting $200?
Here's a couple of quick questions (answers are between you and your hubby only): if you normally itemize your medical expenses on your income tax, do you need the extra expense to improve either this year's or next year's deductible expenses? Are you at, or exceeding, the limit to which you can deduct medical expenses? Do you have any money left on your FSA or FRA which needs to be spent by year-end? Will next year's FSA or FRA give you more flexibility in paying the capital expense of the CGMS than (whatever remains of) this year's will?
If it makes financial sense to put off the commitment, then put it off the few days. If it makes financial sense to jump on it now, then jump. If it makes no difference... talk it out with those close to you.
It seems to me that getting the starter kit and the first box of sensors for $175 would get your foot in the door with the insurance company, and give you a chance to see if the DexCom will really work out for you. As interested as you have been in getting a CGMS, you should go for it.
You're talking about pennies when the real issue is enhancing your health.
My insurance company paid zilch - I paid for this device and sensors myself.
I am a Type II diabetic, and the information this device has offered me is invaluable.
I learned that even though my fasting glucose was normal, I was having wild swings during the day.
With this information my Doctor prescribed a fast-acting insulin, and now my sugars are well under control again.
I know it's tough getting insurance companies to cover what should seem essential tools, but please don't let that dictate whether you use a tool or not.
Your health should come first.
Every insurance company has an appeals process. I too have a company that denied coverage for CGMS. I appealed all the way to the state insurance commission and won. Insurance company is ordered to pay for sensor and supplies. I will share the best advice I received: Don't give up!
Speaking from my experience, I was unsure whether I wanted to wear another device on my body and if the benefits were there. Working with my doctors we obtained approval from the insurance company to do a 5 day trial they covered the cost and it gave me the opportunity to decide. Once I had the monitor I was sold. I go low (down to 40 before I feel the signs) using the alarms on the monitor and know my trends helped during the trail. My insurance like yours denied approval, they considered it experiencemental. We appealed which they denied. I spend the next 3 months gathering data, a new clinical study came highlighting the benefits and for the final appeal I wrote a detailed letter to accompany the data on the medical benefit the monitor would have for both me and reduction of future medical expenses. The insurance company approved the monitor xmas eve. Don't give up:)