Most on a CGM also use a pump. If going by the rules for everything, the cost for cartridges, infusion sets, CGM sensors, etc. would be $17.17 a day roughly. In a year, that is $6266 and that doesn’t even cover the cost of the initial device (Add $1750 for a pump every year) or BG strips and insulin. So diabetics are already a huge loss for insurance companies which is why most states mandate coverage (no federal law yet.)

So what am I saying? I’m saying there’s no real benefit for insurance to cover all this technology. Yes, it may prevent an ER visit once a year, but even then, that only comes out to at most maybe $2000 for an overnight stay. And with proper education, most can recieve just as decent control with BG strips and MDI. And I haven’t been to the ER in 8 years, and only been pumping for 5 years. So the ER excuse is a bunch of bull in my opinion.

While I love my pump and wouldn’t do without it, I see why insurance is fighting so much against it. To cover it, they’d have to increase premiums for all, which seems to be a huge debate right now for the election campaign, employees in the workplace, union contracts, etc.

Thanks for sharing the information about codes, and underscoring that while codes can aid coverage, they by no means guarantee it. JDRF is funding a large clinical trial to gather evidence needed for reimbursement, and has posted tips for how to seek coverage in the meantime — go to http://www.jdrf.org/artificialpancreas and click on ‘insurance coverage.’

Posting that info or only summary info on a blog like this doesn’t really help the person asking the same question next month.

Why so few comments on such a hot and salient topic so critical to this community?

Where’s the buzz???

The last one was just one case that someone knew of. It’ll be interesting to watch Kevin’s site to see if other coverage reasons get publicized.

Also, to clarify, cgmscentral.com isn’t a blog. It’s a patient resource including lots of tools to be used by patients for patients as they work toward securing their own reimbursement. While the site does offer the individual their own blog, it also includes Wiki software for shared page editing (factual data), newsletters, surveys, polls, forums, etc… It’s the answer to anyone who has ever felt silly asking the question that’s already been answered over a hundred times but they just can’t find the information.

I think the wait will be longer than 2009, considering how slow it takes for something like this to catch on. If we see basic coverage for CGMS by 2009, I’d be dancing for joy! But in the mean time, insurance companies would rather pay for two emergency room visits per year than for one year of CGMS supplies.

Emails, Blogs and Groups on the Web are great for some things and not so great for others. Enter the power of the Wiki plus integrated tools for capturing important information and packaging it so that people can quickly and efficiently reference fact…

Everything always comes down to money I guess. As frustrating as that is for me and you and all our brothers and sisters out there.