I have BCBS of MO. As Elizabeth said, BCBS coverage isn't always the same for each area, that being said... BCBS in Missouri had items that applied to me that they want for CGMS (such as my Dexcom) to be covered. Prior to trying to get a CGMS (Dexcom), I found out what my BCBS has as a list to get approved and these are some of the items...
1) Over 25 years of age;
2) Type I Diabetic for X amount of years (which I've had since 1980);
3) At least 3 times a week a blood sugar level of 50 or less;
4) Patient testing at least 6 times daily - or X amount times daily (I would test 10 to 18 times daily and still have lows);
5) Hypoglycemia unawareness;
6) A1c over 7% (my A1c has ranged between 5 to 6% over the last 5 years but I have had a lot of lows);
7) Hospitalization or emergency personnel sent for help for hypoglycemia and/or hyperglycemia;
8) Have night sweats from blood sugar level dropping (forgot name of this condition but I had it - you knowthe condition when your body's liver has to take a "reserve" of sugar to bring up your blood sugar level because you've dropped so low?).
I originally tried to get the Navigator and as the backorder was 2 months long and I needed something ASAP due to my hypoglycemia unawareness, Edgepark got me the Dexcom and said I was approved immediately by BCBS = which was not true (I was not approved prior to receiving Dexcom). I did not get an official approval from BCBS until 2 months later (after me making lots of calls back and forth to both Edgepark and BCBS).
I would call and ask to speak to a "caseworker" or ask to have a "caseworker" assigned to you, then find out what you need to be approved for a CGMS and which products are most likely to be approved, ask if you should contact Dexcom/Abbott/Medtronic directly or if you should have your Endo contact company (Endo usually has a packet of info they have to fill out on you and usually need bloodwork, your written blood sugar levels from a glucometer for a certain period of time, sometimes needed would be paperwork showing amount of insulin to food ratio, etc... this would probably more apply to GHP who tend to find any reason to not approve insulin pump or CGMS as to show that patient is not *trying* and to say that it is the person's fault, etc.).
Good luck on getting approval. Dexcom has helped me and since getting it in May, I've changed my basal rate 5 times! Another thing is that the first week, during the night I would have at least 3 lows PER night (meaning Dex woke me up for a low, I took sugar and then bg went up but then dropped again; Dex woke me up again and I took more sugar/then bg went up and then another round of low...). The first week I didn't get sleep as I didn't realize I was having such a bad problem with lows throughout night. Prior to CGMS even when I would set an alarm at 2 am prior to CGMS, I still didn't catch the lows throughout night.
Again good luck!
Cina
Saturday, November 21, 2009
cgms comparison
Alright, I was just tarred and feathered and otherwise beaten intosubmission regarding cgms. I was told I absolutely need to get it NOW beforeI kill myself and somebody else in the process and then worry aboutinsurance reimbursement later (which I am quite sure will NOT come but Ihave been putting together information to demonstrate the cost SAVINGS to myinsurance provider).
Being a Minimed Paradigm 550 pump user, the obvious choice is to go with theMedtronic system, however given that I will be paying out of pocket for allthe supplies, I at least wanted to see if there was a cost-comparison outthere somewhere for the different systems. (Real CGMS, not "throw yourmeter on the back of your pump for convenience") Any thoughts?
Award-Winning Children's Author, Jeff Nathan, presents
CurricuLaughs
Curriculum-tied Language Arts Education through HUMOR
"... by far, the best set of presentations I have seen in our school system
Dr. Marc Kerble Assistant Superintendent Winchester SchoolsWinchester, MA
". a student said it best. "You Rock!" From the mouth of babes, Jeff youwere sensational. Thank you ever so much!"
Kristine O. Murray Media Enrichment Specialist Maghakian MemorialSchool Brookline, NH
Jeff: I don't mean to blow you off - BUT - it really depends on what anegotiated rate would be with each manufacturer would be, with eachinsurance company. Even if your insurance company won't cover it - (let'ssay you have UHC) if you buy from Edgepark, and have UHC, you can buy at theUHC negotiated prices. That is my understanding anyhow. It is really worthmaking a half days worth of calls to find out who would be the leastexpensive.
That being said, we have been buying pump supplies for 8 years now and CGMSsupplies for over 2 years now and I can honestly say that I have never dealtwith a more efficient DME supplier than Edgepark. We use them because thatis who our current insurance company says that we have to use - and they aregreat. Once you are on their system, you can set yourself up with theironline ordering system and never talk to anybody. Just plug in yourusername and password, then the shipment goes out either that day or thenext (for in stock items) depending on what time of the day that you order.I think that before 2pm est goes out that day.
Good luck.
Bonnie S.
Being a Minimed Paradigm 550 pump user, the obvious choice is to go with theMedtronic system, however given that I will be paying out of pocket for allthe supplies, I at least wanted to see if there was a cost-comparison outthere somewhere for the different systems. (Real CGMS, not "throw yourmeter on the back of your pump for convenience") Any thoughts?
Award-Winning Children's Author, Jeff Nathan, presents
CurricuLaughs
Curriculum-tied Language Arts Education through HUMOR
"... by far, the best set of presentations I have seen in our school system
Dr. Marc Kerble Assistant Superintendent Winchester SchoolsWinchester, MA
". a student said it best. "You Rock!" From the mouth of babes, Jeff youwere sensational. Thank you ever so much!"
Kristine O. Murray Media Enrichment Specialist Maghakian MemorialSchool Brookline, NH
Jeff: I don't mean to blow you off - BUT - it really depends on what anegotiated rate would be with each manufacturer would be, with eachinsurance company. Even if your insurance company won't cover it - (let'ssay you have UHC) if you buy from Edgepark, and have UHC, you can buy at theUHC negotiated prices. That is my understanding anyhow. It is really worthmaking a half days worth of calls to find out who would be the leastexpensive.
That being said, we have been buying pump supplies for 8 years now and CGMSsupplies for over 2 years now and I can honestly say that I have never dealtwith a more efficient DME supplier than Edgepark. We use them because thatis who our current insurance company says that we have to use - and they aregreat. Once you are on their system, you can set yourself up with theironline ordering system and never talk to anybody. Just plug in yourusername and password, then the shipment goes out either that day or thenext (for in stock items) depending on what time of the day that you order.I think that before 2pm est goes out that day.
Good luck.
Bonnie S.
Friday, November 20, 2009
sugar addiction...ME TOO
I, too, and addicted to sugar. I am terrible at it! I could llive on it ....and it is too easy to get. I can grab a nice brownie easier than I can cook a nice meal. I love my veggies, too, but don't have the energy to cook them. I have literally a dozen other illnesses and I am very sick some of the time; I spend a lot of time bed ridden from my M.S. and M.E. also have other thigns...pain is a part of all of them. but the sugar addiction? I TOTALLY UNDERSTAND.
Diagnosed 2007 and struggling. Haven't been testing for a few weeks and have been overeating sugars and carbs. I'm sure my BGs are through the roof.
What a joke. The one thing I have never been able to control for long-- My lifelong addiction to sweets and carbs... now threatening all my vital organs.
I have been having eye irritation- reading tonight that "dry eye" is a common symptom of diabetics and menopausal women- both me- seems to be a door that can lead to more eye problems. Can't wear my contact lenses , which is unsettling. Seeing an eye doctor on Monday.
I have a family to support. Disability is not going to be a good option. Not that it is for anyone, but my house, my family- lots to lose.
I need to get my act together. I don't consult a nutritionist because with lifelong dieting, I could BE a nutritionist- I know everything they tell me. My problem is this addiction - this horrible addiction - I have such trouble controlling.
I have not confided my diabetes to ANYONE except my husband. ANYONE. It makes me feel like such a failure, though I know that's not the whole story. I am significantly overweight, and I am just ashamed of the diabetes. And afraid.
Posted by: "Roseanne Schoof"
Diagnosed 2007 and struggling. Haven't been testing for a few weeks and have been overeating sugars and carbs. I'm sure my BGs are through the roof.
What a joke. The one thing I have never been able to control for long-- My lifelong addiction to sweets and carbs... now threatening all my vital organs.
I have been having eye irritation- reading tonight that "dry eye" is a common symptom of diabetics and menopausal women- both me- seems to be a door that can lead to more eye problems. Can't wear my contact lenses , which is unsettling. Seeing an eye doctor on Monday.
I have a family to support. Disability is not going to be a good option. Not that it is for anyone, but my house, my family- lots to lose.
I need to get my act together. I don't consult a nutritionist because with lifelong dieting, I could BE a nutritionist- I know everything they tell me. My problem is this addiction - this horrible addiction - I have such trouble controlling.
I have not confided my diabetes to ANYONE except my husband. ANYONE. It makes me feel like such a failure, though I know that's not the whole story. I am significantly overweight, and I am just ashamed of the diabetes. And afraid.
Posted by: "Roseanne Schoof"
Rsugar addiction - Alex
I know how you feel about the sugar addiction - have one myself. When I was diagnosed first thing I did was give up soda. No easy task since I would drink 6 cans or more a day no problem. My mind set was that my feet, my kidneys, and my eyes are more important to me. The worse thing for me was finding out I do not have to avoid sugar - it can be like a free pass in your head. I combat it by finding things that are less then 10 grams of carbs (the lower the better) and allowing myself to have them with some protein (usually almonds). The 100 cal chocolate bars work for that, there is a mini eclair that I have found. So far my bg numbers are doing good - guess the a1c next month will tell a better story.
I find distractions help. If you find yourself going for the sugar - find something else to do. Or tell yourself that you can have some but first you have to drink a glass of water, or wait 15 mins, etc. I also find portion control helps - make up containers (or what ever is required) of a healthy amount of the sugar you are wanting. That way when you get the craving you can have some instead of over doing it. I also find eating an apple or orange between meals can help control the sugar craving. You could also try that - when you want sugar tell yourself that first you have to have some fruit and wait 30 min - if you still want sugar then allow yourself some.
I personally find denial and not having any around will make my cravings worse. Knowing I can have some when I want allows me to choose to not want it.
Good luck. You have lots of support here, but unfortunately it is up to you to win this battle.
Take care--Alex
I find distractions help. If you find yourself going for the sugar - find something else to do. Or tell yourself that you can have some but first you have to drink a glass of water, or wait 15 mins, etc. I also find portion control helps - make up containers (or what ever is required) of a healthy amount of the sugar you are wanting. That way when you get the craving you can have some instead of over doing it. I also find eating an apple or orange between meals can help control the sugar craving. You could also try that - when you want sugar tell yourself that first you have to have some fruit and wait 30 min - if you still want sugar then allow yourself some.
I personally find denial and not having any around will make my cravings worse. Knowing I can have some when I want allows me to choose to not want it.
Good luck. You have lots of support here, but unfortunately it is up to you to win this battle.
Take care--Alex
Food choices
As I've stated, I miss pasta terribly. However, since I did Atkins a few years ago, I do know that once I commit to doing it, I am capable of quitting carbs. I won't like it, but being alive and active in 20 years is more important than spaghetti.
Here is the problem for me: I have a non-diabetic husband and take care of three grandchildren under 3 all day long so I'm used to doing a LOT of casseroles during the week, which are of course, based on rice, potatoes or pasta, or baked potatoes with broccoli and other toppings or pizza...things I can get ready while the children are napping, and then just pop in the oven at 5. What do you all cook for dinner every night?
How do you all handle this aspect without cooking two separate meals, which I really don't have time for. This was not an issue for me when I did Atkins, because we had no grandchildren and my husband was living in another state for work, so I was on my own most of the time.
Thanks for any ideas you can share :)Ethel
Here is the problem for me: I have a non-diabetic husband and take care of three grandchildren under 3 all day long so I'm used to doing a LOT of casseroles during the week, which are of course, based on rice, potatoes or pasta, or baked potatoes with broccoli and other toppings or pizza...things I can get ready while the children are napping, and then just pop in the oven at 5. What do you all cook for dinner every night?
How do you all handle this aspect without cooking two separate meals, which I really don't have time for. This was not an issue for me when I did Atkins, because we had no grandchildren and my husband was living in another state for work, so I was on my own most of the time.
Thanks for any ideas you can share :)Ethel
need to check on how much apple to eat
I am now having trouble with constipation. Been having alternating constipation and gloppy stools. Constipation is particularly deadly for diverticulitis.
Everything else I've tried seems to tend to make me more constipated, with the single exception of oat meal.
Nurse back in college said for these sorts of problems she's said an apple a day works wonders. She did not say what size apple. I gather one is supposed to eat a whole apple and not half an apple. Apples were smaller than than now, so I guess that a small apple might be OK.
Someone says that a whole apple (including the part you can't eat) is 13% carbohydrate. Is this true?
It then takes two whole apples and calculates their carbohydrate content based on how much the whole apple weights. They selected a small Gala and a big Rome apple.
\
I went shopping and bought six good sized pink lady apples. I can't stand fresh apples, so I put them through the food processor and pureed them, after removing the parts containing seeds and stems. I left the skins on. I ended up with four cups of pureed apple.
Since I no longer had a whole apple to weigh, I called the store and asked them to weigh an apple. He said one of the pink lady apples weighed .44 pounds, which is 199 g. On line I learned that a pink lady apple weighs 154 g, but these apples were fairly good sized. So a whole pink lady apple from my store at the moment has 26 g of carb?
But a smaller gala apple as weighed in the article contains only 18 grams of carb. So I only need to eat enough apple for 18 grams of carb to eat an apple's worth of apple?
That would come out to just under a half cup of pureed apple per serving. So a half cup of pureed apple is the equivalent of one fairly small apple?
Yours,Dora SmithAustin, TX
Everything else I've tried seems to tend to make me more constipated, with the single exception of oat meal.
Nurse back in college said for these sorts of problems she's said an apple a day works wonders. She did not say what size apple. I gather one is supposed to eat a whole apple and not half an apple. Apples were smaller than than now, so I guess that a small apple might be OK.
Someone says that a whole apple (including the part you can't eat) is 13% carbohydrate. Is this true?
It then takes two whole apples and calculates their carbohydrate content based on how much the whole apple weights. They selected a small Gala and a big Rome apple.
\
I went shopping and bought six good sized pink lady apples. I can't stand fresh apples, so I put them through the food processor and pureed them, after removing the parts containing seeds and stems. I left the skins on. I ended up with four cups of pureed apple.
Since I no longer had a whole apple to weigh, I called the store and asked them to weigh an apple. He said one of the pink lady apples weighed .44 pounds, which is 199 g. On line I learned that a pink lady apple weighs 154 g, but these apples were fairly good sized. So a whole pink lady apple from my store at the moment has 26 g of carb?
But a smaller gala apple as weighed in the article contains only 18 grams of carb. So I only need to eat enough apple for 18 grams of carb to eat an apple's worth of apple?
That would come out to just under a half cup of pureed apple per serving. So a half cup of pureed apple is the equivalent of one fairly small apple?
Yours,Dora SmithAustin, TX
Niacin for lowering Cholesterol
I spoke to my Dr's office yesterday about the advisability of taking Niacin to lower my cholesterol. The nurse said that Niacin doesn't work alone on lowering LDL and total cholesterol, but only raises HDL.
What?
Everything I've read has been counter to this!
She's still trying to talk me into a statin WITH the Niacin.
Either way, my days of taking Niacin may be short lived. I got around the flushing by taking it at night, but I woke up with HUGE blood sugars this morning!
I'm going to give it another go. This morning could be a major fluke. I didn't have much of a protein snack before going to bed last night, but my BG was around 130ish when I went to sleep. Last night was our wedding anniversary and we went for sushi.
SulaBlue
What?
Everything I've read has been counter to this!
She's still trying to talk me into a statin WITH the Niacin.
Either way, my days of taking Niacin may be short lived. I got around the flushing by taking it at night, but I woke up with HUGE blood sugars this morning!
I'm going to give it another go. This morning could be a major fluke. I didn't have much of a protein snack before going to bed last night, but my BG was around 130ish when I went to sleep. Last night was our wedding anniversary and we went for sushi.
SulaBlue
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