A Crusader for Medicare Coverage of CGM

Please welcome Sue from Pennsylvania who will be a regular contributor to my blog. Sue is the wife of a Type 1 diabetic and a crusader for the coverage of Continuous Glucose Monitoring Systems by Medicare.  I will be Medicare age in four years and Sue is fighting the battle to help her husband and everyone like me who follows in his footsteps.


Sue B_Head SquareThis is my very first blog post, so here goes.  I am the wife of a diabetic.  My husband has had Type 1 diabetes for over 15 years.  He’s been on an insulin pump for most of that time.  About five years ago, he got his first Continuous Glucose Monitor (CGM) and it made a tremendous difference in his life.  He has brittle diabetes, hypoglycemia and hyperglycemia unawareness and before he got his CGM , would have episodes of very low blood sugar and in many instances, pass out because of this.  With his CGM, this no longer happened.

In June of 2012, he reached 65 and had to enroll in Medicare.  Since then, our life has been somewhat of a nightmare.  His CGM, at that time, was over 2 years old and starting to act up.  It no longer gave accurate readings and at times when he would go low or very high, it would no longer sound an alarm advising him to take immediate action.  When his endocrinologist wrote a prescription for a new CGM, his insurance company denied payment because unlike our private insurance, Medicare does not consider it a necessary device and in their words it is just a “precautionary” device. We have appealed the decision and had a hearing with an Administrative Law Judge on June 26, 2013 and are now waiting for the Judge’s decision.

For five years, my husband was able to lead a normal life without the constant worry of going into a state of confusion or comatose, especially when driving.  Now all that has changed and it’s put indescribable pressure on both of us emotionally and on him physically as well.  Having these peaks and valleys in blood sugars makes him tired and out of sorts most days.  Since he is gainfully employed and does quite a bit of driving in his job, it’s a constant source of worry that something awful will happen when he’s out on the road.

CGM CrusaderIt’s so hard to wrap our brains around the fact that something that is so lifesaving to my husband (and myself) is being denied by Medicare.  This is especially troubling in the face of the fact that our endocrinologist has gone to bat for us so many times during our quest to get a new CGM because she considers it of the utmost necessity for my husband.

Our hope is that our ALJ rules in our favor and that our insurance company upholds the Judge’s ruling.   After this happens, my mission in life is to have Medicare change their guideline for Continuous Glucose Monitors.