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[IPp] Glucowatch vs. Insurance

I'm so frustrated with our insurance company!!!!  The following is
correspondance between our Dr. and the Employee Benefits dept where my husband
works.   I'd like to have her (the Empoyee benefits admin.) come and check my
son's BG 3 times a night and then go to work the next day!  Sorry this is so
long, but those who also are having this battle - any advice?


Mrs. Mulligan asked me to contact  you about obtasining a glucowatch for
> Devin. The Glucowatch is not just a  glorified meter. It has the ability
> to record continuous blood sugars over  a 13 hour span of time. This
> allows us to find periods of previously  unknown hyper and hypoglycemia.
> No family can test their child every 5  minutes, especially at night. The
> Glucowatch adds safety in that it can  pick up periods of hypoglycemia
> (especially at night when every one if asleep)  and sound an alarm. When
> worn during the daytime it provides constant  feddback as to what current
> blood sugars are and thus allow corrective  action.
> If you have more questions about  the specifics of the Glucowatch, please
> let me know and I can have the company's  representative contact you.
> Ed Holland  MD

Dr. Holland,
> Mrs. Mulligan and I have previously discussed the Glucowatch for Devin,
> I explained to her at that time that the City of Mesa Health Plan will
> pay for basic models of durable medical equipment.  The Glucowatch is not
> considered a basic model.  I had also consulted with a colleague of mine,
> who also has diabetic children, who had also considered using the
> Glucowatch and decided against it because of some of the research she had
> done regarding the accuracy of the readings.  Regardless of that, the
> does not cover this particular item.
> As I explained to Mrs. Mulligan in the past, she has the option of taking
> her request to our appeals board.  If she chooses to do that, she should
> have her husband (who is our employee) contact me so I can instruct him
> the procedure for doing so.  Thank you for your e-mail and your concern
> this child.
Employee Benefits Administrator

> I'm not sure what you consider a "basic model".  There is nothing
> comparable
> to the Glucowatch on the market.  It is not in the same catagory of
> supplies
> as the meters.  As far as accuracy, I would assume that if the FDA
> it, it must be as accurate as our other means of testing blood sugars.
Dr Holland

> Dr. Holland,
> Based upon the information that Mrs. Mulligan provided to me several
> ago, my impression was, and still is, that the Glucowatch monitors blood
> sugars.  That's what a standard glucose monitor does.  The difference is
> the delivery system.  If I remember correctly, the Glucowatch monitors
> blood sugar through the skin, whereas the other monitors it from a blood
> sample that is taken from the body.  I understand Mrs. Mulligan's desire
> for her son to have this device, and we are not telling her that she
> get it...just that the health plan will not cover it.  As for the
> accuracy...I was just relating the opinion of my colleague who studied
> Glucowatch thoroughly before deciding not to get it for her teenage son
> also is diabetic.  She also shared with me that a child the age of Devin
> easily able to monitor his own blood sugar using conventional methods.
> Despite her opinion, the device is not covered under the plan because it
> does not meet the definition of "basic model" as outlined in the Plan
> Document, and Mr. & Mrs. Mulligan can appeal this decision if they wish.
> Thank you for your additional input.
> Employee Benefits Administrator

You are still missing the point as is, apparantly, your colleauge.  There
are 86,000+ seconds in the day.  Even the most intensive blood glucose
monitoring will tell you about 10 of these points.  It tells you nothing
about trends, it tells you nothing about what goes on at night.  There is
not comparison of a Glucowatch to a glucometer.  It is not just o question
of what is monitored, but how and how often.  I would never say that it is
easy to monitor blood sugars.  Try poking your finger yourself about 10 or
15 times a day, and be sure not to forget any of them!  Try it and let me
know how "easy" it is.
Dr. Holland

Dr. Holland, I certainly do not presume to be an expert in this area.  All
I can do is do the research and make a determination as best I can as to
whether or not a particular item or service is covered under the plan.  I'm
also not that naive about the process that diabetics must go through, as my
dad has Type II diabetes which is thankfully being controlled with very
little medication, and I have a very good friend who is insulin dependent
and has been for most of his life.  I am very aware of the fact that
monitoring ones blood sugar is no picnic.   However, setting all of that
aside, when Mrs. Mulligan first approached me regarding the Glucowatch, she
directed me to a website, which I reviewed at great length.  Here is what I
wrote to Mrs. Mulligan on June 27, 2002:

"...based upon what I'm reading on the website, this is not something that
your son would be able to wear all of the time.  The sensors, which come in
packs of 16 for about $70, only last a maximum of 12 hours, and must be
replaced every time the watch is worn.  The website also issues a clear
warning that the watch is not a substitute for using a regular glucose
meter.  The website also says that it has only been tested on adults over
age 18, and is not recommended for anyone under that age, even though it is
FDA approved."  Now unless something has changed significantly in the last
6 months, I can only assume that the information provided on the website is
still valid.  If this is not the case, then please let me know.

I understand that from your perspective, and perhaps from that of Mrs.
Mulligan, the information that the Glucowatch can provide may be of value.
However, is it considered medically necessary for managing this child's
diabetes?  Perhaps it is, but from what I have been presented in terms of
documentation, I cannot validate that it is, nor does it meet the criteria
for coverage as outlined in the plan document.

Based upon the documentation that was made available to me at the time, I
made a determination that the glucowatch was not a covered item under the
plan. I stand behind that decision at this time.  Once again, if Mr. & Mrs.
Mulligan do not agree with this determination, they can make an appeal to
our advisory committee, which will be meeting again on February 6th.  I
would be happy to help Mr. and Mrs. Mulligan through this process if they
wish...all they need to do is contact me.

Thank you again for your concern for this patient, and for your comments.

Employee Benefits Administrator

email @ redacted
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