Wednesday, August 19, 2009

Health Care Issues

Getting back into the swing of diabetes-management is always a challenge, when you've drifted far from the coast of control for so long. But that's been my adventure for the past couple weeks, and it's revealed the surprise and realization that - despite my thoughts to the contrary - my health hasn't been all that out of whack. A recent A1C was higher than it should be, but had dropped from the one more than a year ago. With the aid of a new Minimed Paradigm 722 that came to replace the now-discontinued Deltec Cozmo I'd navigated for two years, all seemed well again in the carb-counting and blood testing world as the levels are becoming more consistent and pleasing to the eye. The D-Life seemed good, once again.

Then came the unexpected battle this week, one that may evolve to other levels in the coming months.

With my push for tighter control, I'd discussed with my trusted endo that it would be a good time to explore the CGMS. We agreed recently to move forward, and I received a call early in the week from her office about drafting a letter to the insurance company to get this wonderful device. Her call came. I'm told, "We're going to go with the IPro device, rather than the Minimed-style of the CGMS." I ask why. I'm told that she'd been drafting a letter for the regular version, before realizing who my current insurance carrier was with. That changed things, she explained. Why? Well, because this insurance carrier doesn't typically approve a CGMS for diabetics unless they have regular readings under 50. If they aren't that low, the paper-pushers decide it isn't medically necessary - regardless of whatever the patient's doctor might think about that. I object, and she reminds me that "doctors don't determine what's medically necessary, after all, it's the insurance companies..."

This, of course, lit a fire underneath. I argued. Remembered after a few minutes of ranting that this doctor's office woman wasn't the one to get into a healthcare debate with, and apologized and calmed down. But only enough to tell her to draft the letter for the regular CGMS that would be compatable with the insulin pump I'm wearing, rather than the one that isn't. If the insurance company denies it, then I'll cross that bridge if that happens.

As many diabetics can relate, I have had the occasion of waking up in my own bed to the sight of paramedics hovering above me and an IV stuck in my arm. All because my night-time sugars get too low, and I'm not able to catch it before the reaction sets in and my wife can't control me without the risk of a black eye consequence. I'd rather keep my sugars higher, therefore resulting in worse control but also the no-reaction reality I'd prefer. If my health insurance company would rather pay for that worse control and all of the higher-cost consequences down the road, not to mention any reaction-related costs of going low because they won't pay for the device to better monitor things, than that's their choice. Not rationale, but it's there's to make under the current screwed up system.

Another example of why the current health care debate isn't functioning adequately and needs some type of change - whatever that may entail.