Decisions Decisions

I’ve been away for a while, life getting in the way. I’m sure you know how it is, work, sports, kids and just life in general. Anyway on to my subject.

About a week ago I had to call Medtronic to order some more sensors for my CGMS. All went well with placing the order and they told me that they would turn it in to my insurance and I should have my order in about 2 weeks. I had to giggle a little to myself when they said that they were going to turn it in to my insurance. I’m type 2 and not exactly the ideal candidate for a cgms. My blood sugars are generally in the normal range, decent control and meds work well for me. I have never been to a hospital for a severe low or high condition. I do have hypoglycemic unawareness but that is not what the insurance company is looking for to decide if I qualify for sensors. When I first got the cgms earlier this year I knew that my insurance wouldn’t likely pay for the sensors but we sent it to them anyhow. I was right that they wouldn’t cover them. The letter I received said that they were not medically necessary.

I know that I could probably manage this disease with out the cgms but I really believe that if there is a tool out there that makes control even just a little bit easier then I’m all for it. Hence my need (or want?) for a cgms.

Now we have worked our way up to yesterday when I received the letter from my insurance company that said that they deemed the sensors to not be medically necessary for me. This time they included a document explaining how I could appeal this decision if I wished. The letter also spelled out what they would pay for if I won the appeal.

Here is where the decision part comes. The letter explains that if I appeal their decision and win they will pay for two separate seven day testing periods in one year. Putting the math to that and it comes out to about $210.00 worth of sensors.

Is it worth it to jump through all the hoops involved in the appeal process to end up with an extra $210.00 a year? Unfortunately for me the math just doesn’t work out. I think I’ll spend the time I would have fighting for coverage hanging out with my kids, in the end it’s probably a better investment of my time than arguing with my insurance company over a couple of hundred bucks.