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Re: [IP] Convincing Blue Shield...

The one thing that helped with a favorable decision for my MM 507C was
"hypoglycemic unawareness", which should be supported by your dramatic drop
in A1C's. However, this WILL need to be substantiated by your prescribing
endo. Mine was further helped by the fact that I needed third-party
assistance with a recent  hypoglycemic reaction.

Todd Merkle

----- Original Message -----
From: "wombn" <email @ redacted>
To: <email @ redacted>
Sent: Monday, October 09, 2000 11:32 PM
Subject: [IP] Convincing Blue Shield...

> As my profile said, I'm looking into pumps and working on
> convincing my insurance company (Blue Shield of California) to
> cover it.
> They rejected the humalog pen just last week, telling me that it
> wasn't a "medical necessity" and that they cover syringes.  Well,
> the only time I got a syringe prescription (March), they rejected it
> and I had to pay full price.  So either someone's confused, lying,
> incompetent.... or they've changed policies recently.
> The MiniMed packet my endo gave me has a form to fill out where
> they'll take the info, and contact my insurance for me and try to
> convince them to get coverage for me.
> I'm wondering if I should include a note explaining a few things
> about myself--hopefully to give them more fodder.
> For example, I bought a GentleJet (from Avanta) out of pocket for
> $500 because I was simply far too needlephobic to do injections.  I
> tried injections for 4 days (9 injections in all) and began waking up
> truly suicidal.  I didn't want to get out of bed.  I didn't want to even
> wake up.  I started imagining ways of "getting it over with" very
> quickly and realized that I had the tools I needed right there in the
> fridge.
> The logical part of me was very alarmed at those thoughts... So I
> stopped all injections and started looking for alternatives.  I found
> GentleJet (needle-less injection using high powered spray) and
> Autoject 2 (which is a lancet type device that plunges the syringe
> for you at the push of a button and you don't have to see the needle
> go in).
> The GentleJet hurts like hell if you do it even slightly wrong.  But
> that's less important to me than the needle is.  That's how
> needlephobic I am.  I have little problem with mild pain itself  And I
> have my teeth drilled without Novacaine--just to avoid the needles.
> There is nothing rational about this phobia and it doesn't respond to
> logic of any kind.  It's more a like Beast that takes over and has
> total Rule.  I tried to contact Behavioral Health, but they didn't even
> return my call for more than a week, so I figured they wouldn't be
> much help in the short run if they were that overloaded and
> unresponsive.
> Recently, my Jet was clogged and I had to switch quickly to the
> Autoject/syringes.... and I can't re-adapt a previously-adapted vial
> so I can't use the Jet again until I refill my insulin prescription.  It's
> working ok, except that I'm finding myself "forgetting" to inject.
> I wanted to try the Pen to see if I'd made *any* improvements in my
> needlephobia, but since they rejected it, I can't find that out..  And I
> still can't even tolerate the thought of injecting without the Autoject.
> Although I can now look at a needle and draw up the dose without
> going into panic symptoms.
> There's a couple of other things that might make them change their
> minds:  I'm actively working on getting pregnant and I'm 38 y/o
> (never had kids, finally in a marriage where I WANT kids).
> And I frequently forget that I'm even supposed to inject anything.
> Moreso now that I'm using the Autoject w/syringes.  Such as this
> morning, where it took me 4 hours to remember that I'm supposed
> to inject insulin several times a day.  (Must be a form of denial or
> avoidance or something.  I can't quite pin it down).
> Also, I've changed careers recently.  I used to be a completely
> sedentary database programmer.  Now I run a small janitorial
> company with my husband and have frequently had hypos while
> alone in buildings that I'm cleaning or inspecting.  Scared the
> dickens out of me the first time.  I refused to work at all for several
> weeks.  The exercise is good for me, but the being alone part isn't
> and we just can't have me accompanied all the time.  Our profit
> margin is very very slim and we can't afford to double up.
> My endo says that I"m also very insulin-sensitive (probably cuz I'm
> still underweight) and take such small amounts that it would be far
> easier to have tight control on the miniscule amounts capable with
> a pump.
> The biggest impediment to convincing them is my A1C:  6.7%,
> down from 12.1% at diagnosis last year.
> Can you think of anything else I can use as ammunition and do
> you think that any of the above has a strong enough case convince
> them?
> I really want at least the *chance* to try this.  The idea of inserting
> a cannula (such as that soft short one for thin people on the
> MiniMed page) every 2-3 days, as opposed to several times a day,
> is really attractive to me.  Especially now that I'm stuck with
> needles again several times a day (MDI -- which is the only way I
> can hope to avoid hypos in those buildings).
> Any ideas would be very very very very gratefully received!
> ----------------------------------------------------------
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