Determined Mom and Daughter Take on Blue Cross And Win Their Battle for a Continuous Glucose Monitor

Our publisher, Nadia Al-Samarrie

| Apr 2, 2008

Hello to all of you hardworking diabetes educators. We have some exciting news from California! It's about the first case of a health insurance company paying for a patient's continuous glucose monitor, as well as the ongoing monthly supplies. It's also the story of a mother-and-daughter team that had the courage to blaze a new trail for us all. These two women, Laura and Gillian Miller, truly went where no man has gone before! That's why Diabetes Health Professional is honored to tell their story, which you can read on page 27. 

When Blue Cross rejected the Millers' request for a continuous monitor, it cited a reason we've often heard before: that a continuous monitor isn't considered routine or commonplace enough to be considered an everyday part of diabetes management.  This despite the fact that the continuous monitor offers a huge helping hand to people with diabetes in achieving consistently better BGs and, therefore, a better shot at long, happy and productive lives. 

Of course it is the nature of large institutions to resist change and be wary of innovations that may later turn out to be ill-advised or even harmful. But we also know that even non-profit companies like Blue Cross will often reject common-sensical claims to save money.

But in this case, continuous glucose monitoring (CGM) has been around long enough that, thanks to people like the Millers deciding not to take "No!" for an answer, insurers' resistance to paying for it is beginning to crumble. State regulators are also beginning to scrutinize health plans' denials of CGM. 

In fact, this may be the beginning of a move toward routine coverage of continuous monitors by insurers. Alan Marcus, director of medical affairs at MedTronic and a good friend of Diabetes Health Professional, is hopeful that "within three years we should expect to see almost universal coverage of continuous monitors by insurers." 

When that happens, keep Gillian and Laura Miller in mind. They are among the trailblazers who are opening doors for other people with diabetes who could benefit greatly from continuous monitoring.

Continuous monitors are proven and available now, but are being unnecessarily restricted and rationed by the powers that be. Please support me in helping patients get the tools they need to live well. Let's work together to keep up the pressure on insurers to make coverage of continuous monitors routine. 

(If you'd like to read more about the benefits of CGM, go to www.diabeteshealth.com and type CGM in the search box. We have almost 400 articles that we've published about this particular technology. Also, I'd love to hear your success stories with patients who are using CGM. Please e-mail me at nadia@diabeteshealth.com.)

On Another Note:

Speaking of people with diabetes who have overcome great challenges, take a look at our article on Scott Dunton (page 37), who was diagnosed with type 1 at age 16. 

Five years later, Scott is a professional surfer who not only ranks high among the world's top competitors, he has learned to live extremely well with his diabetes. 

So, if you sense an undercurrent of optimism running through this issue, you're right! 

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Categories: CGMs, Diabetes, Diabetes, Making a Difference


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Comments

Posted by jkaptena on 14 August 2009

Hello, my name is Jody and I have been a type 1 diabetic for 38 years. My kidneys are still working thank God. I am currently receiving Social Security Disability and I am trying to get medicare to preapprove coverage for a CGMS. I have been on a Paradigm 722 insulin pump for 2 years. I no longer have any warning signs of low blood sugar and I try to test my BS every 2 hours. Medicare will only approve coverage to test my blood sugar 4x a day. Medicaid is my secondary insurance and they say that they must follow medicare guidelines. Glucagon is not covered by medicare they feel that I should be able to chew glucose tablets while unconscious from hypoglycemia. I would like to know how to go about getting a CGMS approved. This is a life or death situation with me. A CGMS is a necessity not an option. any information that would be helpful is greatly appreciated. Thank-you for any info or guidance. Jody


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