250.01

I, Christopher Snider, do hereby authorize DexCom to submit claims to my insurance company/companies on my behalf, and my insurance company/companies to make payments directly to DexCom for my continuous glucose monitoring products.

I swung by Not House’s office Tuesday morning to get his John Hancock on the bottom of the last form to see if I can join the digital revolution – I can haz Continuous Glucose Monitoring Systems? I’ve done a lot of complaining about Lantus, about my (self imposed) restrictive Humalog use (although that is finally changing), about my obsession with control, about my feelings of helplessness, about the questions I still have with no answer in sight, about the uncertainty, about the fear, about the anger, about the frustrations, about the…well you get the idea. A lot of this stuff is Negative Nancy-ville. I could use a little hope.

So with this documentation and fax delivery confirmation I’m taking a step to finding some answers. I don’t know how long it will take, I don’t know if there is enough data to support my joining the revolution, but I have to try. Specifically to the “enough data”, I do have some concerns after looking at these forms over the past few days.

The first thing that stood out was the “Last 2 HbA1c Lab Results” – 7.5, 9/3/2009. 6.9, 3/2/2010. When I first filled this out I was worried that this simple sign of progress would not bode well for my case. I still have to get over the mentality that a CGM doesn’t mean that things are “out of control”, more that this is a tool for greater control regardless of where you start. If I can get to 6.9 despite the current shenanigans, the possibilities with a CGM seem very promising. Maybe a CGM will help me figure out 2pm to 11pm and reduce the number chasing that goes on far too frequently.

“Number of diabetes-related hospital visits within the last year….number of paramedic visits within the last year….number of low blood glucose events requiring assistance from others in the last year.” Knock on wood, so far so good. Again, there is a part of me that worries that this doesn’t help my case. I’ve seen the DexCom do its thing. I’ve read about how it has accurately predicted an epic drop before it was too late. But if that hasn’t happened to me yet, will someone see this and say “this isn’t necessary”?

“Patient’s existing conditions supporting medical necessity for long-term continuous glucose monitoring system…” Compliance with medication, diet and MD treatment? Check. Fingerstick blood glucose tests? Check. MDI? Check. Endo? Check. Completed comprehensive diabetes education? uh, about that…

“Clinical indications for long-term continuous glucose monitoring system…” Here’s where I have had some serious head-scratching moments. Aside from the recent A1C value, the only box that I can check with all sincerity is “inadequate glycemic control despite appropriate adjustments in insulin therapy and compliance with frequent self-monitoring”. I feel like I should put an “#IMHO” after that one. I worry that my A1C is providing evidence contrary to what I’m feeling. I know it’s just a 90 day window, I know there’s more to Diabetes than that single number, I know now is not the time to quit or give up hope – but is the information I’m providing, the information that they are requesting, giving sufficient proof of medical necessity? Luckily, there is one more section to this form that I’m hoping will make a strong closing argument.

The one thing I smiled at when I first scrolled through this form was the 30-Day Blood Glucose Log. If only because I knew filling out this section would be a breeze. My current log book has blood glucose and time tested recorded since October 28, 2009. I started recording insulin doses on January 5, 2010. If anything is going to show my troubles after lunch and thus my primary reason for this device, this 30-day log should do it. *fingers crossed*

Control is a relative term, but I think I have it. And yet I know there is great room for improvement. Given the hypothetical future, this might give me the enlightenment I need when it comes to my Lantus (that I loathe). I’m still worried that some paper-pusher will look at the data provided and without thought or analysis break out a ‘denied’ stamp. But I have to start the process. I have to try. I’m looking forward to the possibilities.

[Oh, and about the title. One of the form fields asks for an ICD-9 Code. Wikipedia, among other Google search results told me 250.01 stands for “Diabetes mellitus type 1, without mention of complication”]

5 thoughts on “250.01

  1. Chris!! This is awesome.

    In my experience, the biggest concern for me was the roller coaster i was experiencing. Testing 15 times a day and still no change in A1c. That is what got them to give me the Dexcom.

    If this works out for you insurance wise, I am SO ecstatic for you! You will LOVE it the way you loved using your meter software, only a hundred times better!

    If and when you get to use the dealio, ere are my suggestions after four and a half months of use:

    1. Try not to look at it unless it alarms. Use the data in retrospect to adjust your insulin and not as it comes. If you don’t do this, you could risk over dosing and completely hating the experience. The overall data is my favorite part. Also, another thing I did was for two weeks, print off the graphs daily and mark what food I ate when. This gave me a better idea of how which food affect me.

    2. Be sure to let the sensor set overnight before starting it. The trainer won’t tell you this (well I shouldn’t’ say that, they might, mine didn’t). Otherwise, you may get sensor failures or ???’s instead of a reading during the first 24 hours (which when you first start using it is really, really frustrating).

    Hope you get approved.

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    • I definitely agree with #2 here. I always physically put in the sensor at night, then “start sensor” in the morning. That extra time to get settled means the Dex is more accurate right away.

      Finding the balance of checking the Dex and not checking takes some time and it will depend on you. I check much more often than most people (in my opinion), but that has led me to a string of A1Cs right around 5.9.

      Best of luck to you in this next great step for more control!

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  2. Chris, if you don’t get approved (Not House should help you here!) you can do a trial of one! I did and can send you the contact info! The clinic did all the paperwork for me…

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  3. I know I’m way late, and there’s probably an update on this in the posts I’ve yet to get to. Hopefully they are posts about good news and new tools.

    Why shouldn’t “inadequate glycemic control despite appropriate adjustments in insulin therapy and compliance with frequent self-monitoring” be all the cause we need? I hate how everything comes down to money.

    Like

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