Wednesday, April 25, 2012

Necessary Coverage

Insurance coverage is always an "interesting" topic for those of us living with diabetes.

Or more to the point: the struggle to get what appears like logical coverage is always a tug of war that too often seems to leave one side face down in the mud pit.

We have to fight the fight, pretty much every time we need some of the necessary medical supplies and life-sustaining medications in our D-Lives. So, just thinking about using a new D-device, especially one that's just recently-approved by the FDA and hot of the presses, can be a tad bit daunting and stress-inducing.

That's what came to my mind when the recent topic of the mySentry came up at the Medtronic Diabetes Advocates Forum and everyone was talking about how insurers might want or not want to cover this new device given FDA-approval in January. Especially since it might not necessarily be seen as "medically necessary" at this early stage.

Source.
In many situations, it seems as though people might simply choose not to pursue these D-devices or supplies simply because of the expected resistance in trying to get coverage (assuming we have it). So with this new device, people might just choose to wait or not even ask for coverage.

But an interesting aspect of this discussion opened my eyes about the path to insurance coverage for these new devices. We heard how simple requests for coverage, even if we're denied, go a long way and set the stage for how insurance companies view the need to provide coverage for these devices and supplies. Insurers don't see much credibility in the Pharma or medical device companies telling them that their products should be covered. The response is basically, "Well, of course you want YOUR products covered!"

But when it comes from us, on the patient-end, the insurers see that need demonstrated in actual numbers that show there is a need for coverage. The more we ask, the more they'll see "hard data."

This is similar to the CGM Anti-Denial Campaign that Gina Capone created and led, and the Medtronic executives watching this issue on mySentry believe coverage will gradually expand in much the same way. At least two insurers are already covering (Ohio State Health Plan and AvMed Health Plan in Florida), and there's scattered reports on Children With Diabetes forums and in other places online that show other companies are at least offering some coverage.

The bottom line is that even if there's a basic desire to get coverage for one of these devices or supplies, we should go for it. Even getting "denied" by insurers means that we're putting a piece of the puzzle in place and showing the need for coverage.

Disclosure: As detailed in this recent post, I've been given the chance to trial test the mySentry and I'm going to embrace that offer and write about my experiences, whatever they may be. But whatever is decided and however this test-run plays out, it doesn't change the fact that we need to advocate for coverage. This goes beyond any one individual person or small group of people; it's about the larger D-Community and insurance coverage for not only for this device but for all devices and supplies that so many of us need.

So, let's get to it. Time to advocate for what we need.

6 comments:

Jacquie said...

I'm going to start making a HUGE wish list. This is a great point and one I hadn't really thought about yet. Good luck with YourSentry. :)

Kelly Booth said...

I agree Mike. So many people get the "my insurance won't pay for it" attitude and don't want to bother. When I first tried to get a CGMS, everyone told me that wasn't possible because Medicare won't cover a CGMS. It was denied, I appealed and won my appeal. You can't win if you don't try!

nidhi gupta said...

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Maia Dobson said...

I would vie for a health insurance that would include dental plans for complete health protection. The government should employ dentist in Champaign IL to areas that are less fortunate with oral health provisions.

private health insurance said...

Very good point Mike. Sometimes you just have to give things like insurance companies a little push to get the ball rolling.

Stew said...

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