Dear Judge Smith

Sue B_Head SquareDear Judge Smith:

It has been over four months since June 26, 2013 when my husband had his Administrative Law Judge hearing with you in order to appeal Freedom Blue’s denial of coverage for his Continuous Glucose Monitor (CGM).   My husband, his endocrinologist and I all testified regarding the necessity of him having a CGM to prevent a catastrophic episode of hypoglycemia that could cause him to lose his life because of extremely low blood sugar.  We presented you with numerous charts and exhibits so that you would understand how quickly his blood sugar can plunge from normal to low with the result that he can’t make the necessary corrections by himself.  In some cases, he has had to be revived by the EMS.

To date, we have heard nothing from your office.  We are anxiously awaiting the determination and thought that it would come in a timely manner due to the seriousness of the situation.  We were originally told that we would get the decision in four to Mailboxsix weeks.  After four months we are now well past that period of time.  I called your legal assistant and was told that we could not get any information until the decision was mailed.  All he could tell me was that it was “in queue.”  What does that mean?  Do we have to wait weeks, months or even longer to find out whether we got a favorable or an unfavorable decision?  In the meantime, each and every day of my husband’s life, I worry.  From the time he leaves the house for work until the moment he gets home at the end of the day, my mind is constantly wondering and praying that he’ll come home to me safely.  Our frustration is at an all time high.

There is something so wrong with the entire system.  There are many men and women in the same position as my husband who desperately need the CGM and sensors and can’t afford them.  There are many men and women who have gone through or are now going through the Medicare Appeal process who will have to wait for many months in order to get their decisions.  Does someone have to die before any of this changes?   I sincerely hope not.  In the meantime, we wait and wait and wait each day for the mail in hope that the decision will finally be here.

Very truly yours,

Sue from Pennsylvania