Sunday, March 20, 2011

Washington state's take on blood glucose monitoring

I live in the Evergreen state (Washington) and if you read the Wall Street Journal you might have seen this article that talks about how 11 physicians met to discuss if it was cost effective to continue for the state to pay for children with diabetes to receive test strips enough to check their BGL more than once per day. My children get their health coverage from a state program called Apple Health for Kids.  We actually (almost) experienced first hand what this could be like for families.  Each year, we go through a re-evaluation to determine if our children are still eligible to receive benefits through this program.  February was our month to be evaluated for 2011.  When they reinstated our benefits, they put in April 2011-March 2012, leaving out March 2011.  Imagine my horror when I open a letter from our insurance company (Columbia United Providers) telling me that the claims pending for Bekah's endo visit and pharmacy needs were denied.  I called and was treated very poorly (a first for me in dealing with CUP) by the woman who answered the phone.  She all but called me a liar and told me "they almost NEVER make mistakes at the state level".  Many phone calls later (taking multiple hours of wait time) and I was able to resolve the issue.  We could not get back on CUP until April so I had to used the open coupon to get what we needed for the month of March.  When I called the pharmacy to let them know how to bill for March they called me back saying that the state would only allow 100 blood glucose test strips for 90 days.  I told them the situation and they had our prior-auth on file so  they made the calls necessary to get the test strips that we needed.  (Thankfully I have a few great friends in the DOC that had sent me some strips a few months ago and I was able to tap into those to get us by until the issue was resolved)  It only took a couple of days to get the answers that we needed and got the 300 test strips for March.  I didn't get the open coupon to pay for the blood ketone strips but I have a couple of boxes of those stashed so I chose not to fight it. 

It seems a little scary to me that it was even a question in the state's mind that we would need to be testing Bekah's BGL more than once per day.  It makes me sick to think about having that restriction.  I was ready to write letters and even show up at the door step of whomever I needed to get what I felt was necessary to care for my daughter.  (This cowgirl can play rough if necessary) 

The other thing that was in question at this committee meeting, in regards to children with diabetes, was the coverage of CGMS.  As much as I would love to have a continuous glucose monitoring system for Bekah, I am able to get by with out one and we still see some pretty great numbers and have minimal lows.  A CGMS would help me to detect lows a little before they happen (although Bekah is pretty good at catching them in the 70s)  and maybe be better about catching those high numbers to be able to keep a better glycemic control.  We had a random 430 the other day (I think there must have been a bubble in her tubing) and we could have corrected sooner with a CGMS detecting it.  Her last A1C was 7.2% and I am happy with that although I would love to see it a little lower and a CGMS might help with that.  The committee voted against the coverage of CGMS .  They decided that it doesn't impact the quality of life of a child with diabetes enough to justify the expense.  I think I have to agree.  There are a lot of things that the state needs to spend money on and CGMSs are really not a necessary expense (unlike test strips). 

Since a CGMS is something we will have to pay out of pocket for, I have done some research and decided to put my money aside for a DAD instead.  A diabetes alert dog is an investment that I am excited to make.  We had a Siberian husky for almost 11 years.  Dakota died just a few days before David was born.  It has been 2 years and I think it is time to get another dog and why not a DAD.  There are many programs out there and our family has decided to go with Warren Retrievers.  I have talked with the owner, Dan Warren, multiple times and his method seems to be top notch and very family oriented.  It's not a cheap endeavor but I think would be similar to a CGMS out of pocket over 3 years or so. (If you decided to get one too and go through Warren, tell them I sent you)

It's not the best picture of our beautiful Dakota but here you can see her ready to play


  1. Wow, I can not believe that they would even consider limiting test strips to one per day! One???!!!! So glad they voted down that idea!!!

    So sorry you had to go through all of those insurance hassles!

    I would LOVE to get a diabetes dog, too.

  2. lucky for us the doctors know that it wasn't reasonable and it didn't pass.

  3. OMGoodness Heidi...what a fiasco to have to endure. I am so glad that it ended up working out OK. The D.A.D. sounds like a wonderful idea for Bekah and the family. How's my app. going!? I'll pimp you guys out big time if that bad boy goes live!!! xoxo

  4. This totally boggles my mind, that they'd consider limiting strips and say that the results of doing multiple tests are "uncertain." I'd be interested in seeing those public documents unveiled before that meeting... What is even MORE scary about this is the fact that these are physicians. Not even sure how to wrap my head around that... Anyhow, thanks for sharing this with us.

  5. It is scary to know how much power insurance has in our lives. They have us by the hair, that is for sure.

    I'm so glad it worked out. We would have helped fight if you needed us! ((HUGS))

  6. ONCE A DAY?!? That is ridiculous. I can't even let myself go there or I'll never get to sleep...! Personally, we LOVE our cgm and I think I'd have a major meltdown if we ever had to do without it. But Sweets does not ever feel her lows- not even a 29. :( But its not for everyone... I think a DAD sounds like a wonderful addition to your family! Good luck!!!