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

7 thoughts on “Dear Judge Smith

  1. Sue, this is such a heartfelt plead to get some help for your husband and all type 1’s on Medicare to get the safety net they so desperately need. I hope you get the decision soon.

  2. Sue, Well written, just too bad you still don’t have an answer. Would it be ok to post a condensed version on my facebook page if I leave out your name? I understand if you don’t want me to use your words. Just let me know:) Judy

  3. Sue, What can we do, as the DOC, to help get your decision as soon as possible? Is there a Twitter account, an email, an address – anything at all – that can help show our support in requesting a timely answer? How frustrating to stand on the sidelines and know that you need a decision – one way or the other – in order to get help! Let us know what we can do besides support you on this page…

    • I spoke to the Judge’s Legal Assistant this morning and unfortunately, nothing can be done. In 2012 they were getting 1000 Medicare cases a month…in 2013 because the baby boomers were starting to go on Medicare, they are now getting 10,000 Medicare cases a month. They are not allowed to hire any help nor are they allowed to put in overtime. I think that the more people who file these appeals when they are denied the CGM, the more our voices will be heard. This goes for the boomers but also for anyone who will be reaching Medicare age in the next few years because they might also be in this position when their time comes. We have to get our voices heard.

      I appreciate your reply to my blog. It’s so important to me that everyone realize the necessity of getting that word “precautionary” out of Medicare language. The CGM is not a precautionary device…it’s a preventative device.

  4. I’m sorry to hear this is not just dragging on, but that you are at a stand-still, being forced to wait for either answer. As someone who feels incredibly dependent on my CGM, I can imagine your fear for your husband. Reading those statistics from the Judge’s Legal Assistant is daunting. Precautionary vs preventative…. wow. Thank you for sharing this.

  5. Sue-As someone who will be on Medicare in 4 years, I thank you for of all the hard work you are doing not just for your husband, but for all who are on or will be on Medicare. My CGM is my GPS for a safe life with Type 1 and I hate the thought of being without it.

    Once again, another powerful and heartfelt post.

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