Baby Steps

Sue B_Head SquareFor months I have been blogging about the roadblocks my husband has faced in getting a CGMS. He used one before going on Medicare, but a replacement system prescribed by his endocrinologist was denied by Medicare. We went through Levels 1, 2, and 3 of the Appeals process and had a hearing with an Administrative Law Judge on June 26, 2013. After being promised a decision in three months, we are  at seven months and still waiting for the judgement to be drafted so that we can find out if we got a “Fully Favorable Decision” or not.

In the meantime, I have been in contact with a Legislative Assistant of Representative Carol Shea-Porter [D-NH1].  In December 2013 Shea-Porter introduced a bill into Congress (H.R. 3710) which provides for coverage of Continuous Glucose Monitoring Systems by Medicare if recommended by a doctor. Unfortunately this bill is being given little chance of passing, but I believe it is an important step in bringing attention to the important issue of CGMS coverage for senior citizens.

I have also been in touch with the Global Marketing Director of Dexcom and she has indicated that together with Medtronic, they are forming a coalition to plan a big legislative push with respect to CGMS and Medicare.

I have been cautioned that it is too early to become excited about a speedy change in Medicare policy. But for me this is exciting news. I have gone from feeling totally alone in my crusade to knowing that a Congresswoman, Dexcom, and Medtronic are taking steps to influence Medicare to change the guideline.  For the many diabetics on Medicare who need a CGMS and can’t afford the cost of the device and sensors (my husband being one of them), there is a glimmer of hope that victory will be achieved now that some of the big-time players are becoming involved in the fight.

Climb the MountainThe steps being taken now are just baby steps and it is still a long way to the top of the mountain. There will come a time when I, together with many others, will need to have our voices heard. We will need a groundswell of support from the Diabetes Online Community to help change Medicare policy to provide for CGMS when medically necessary for senior citizens with diabetes.

Right now we are in the early stages of figuring out how to do this in the most effective way. I urge you to keep reading Test Guess and Go as we update our progress.  Please contact me if you have any information or contacts who will be helpful in pursuing this goal. If you are on Medicare (or will soon be on Medicare) and are concerned about your safety in living with diabetes without a CGMS, please reach out to me to add your name to my growing list of advocates.

Baby steps.  So small, but the first steps on the road to victory.

20 thoughts on “Baby Steps

  1. Sue, I’m really glad you’re pursuing this. As someone who will be in your husband’s shoes in about 13 years, I applaud your efforts and offer my support too.

  2. You know I’m in. Your blog is awesome. It summarizes the concern my husband and I have with Medicare.

  3. Thanks to all. We are in the process of getting organized. kneel checking for our updates. Any ideas are very welcome.

  4. Meant to say “keep”. Easier to write on my big computer rather then my IPad.

  5. Sue, excellent, excellent blog. We definitely need to keep that glimmer of hope alive. Baby steps lead to leaps.

  6. I knew a little about this from reading your past posts but we talked more in-depth about it at the Medtronic Forum. You have a lot more people fired up about it now and ready to fight in your corner. Keep us posted on how we can help!

  7. Thank you Sara. We are in the beginning stages of trying to figure this all out and I will definitely keep you posted by updating on testguessandgo. It’s going to take a village to do this so any help that I can garner would be terrific.

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    • The biggest help would be to contact everyone you know and ask them to contact their Congressperson. Thanks for asking.

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  13. This is (unfortunately) and lengthy process, but I think you’ve done a great service by bringing attention to the issue! Thanks!

  14. I am not done yet. I’m going to keep on and hopefully will affect a change in the guideline for the CGM. I will continue to bring attention to this matter in any way that I can. I knew from the beginning that this wasn’t going to be easy…and believe me…it hasn’t been, but like my blog says
    “Baby Steps”.

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