Pumps, Continuous Glucose Monitors (CGM), and Insurance Companies…ugh!

I remember Abbie asking about not taking so many shots at her Endo appointment in July of 2018.  He said we could talk to our CDE about pump options and hopefully by the next appointment have a pump ordered and be in training.  So we went next door to the Diabetes Education Center and we were shown three different pumps our insurance would cover as well as two different continuous glucose monitors (CGMs).  Let me tell you  this was a lot of information in a short period of time.  We were shown the OmniPod, the Tandem Tslim X2, and the Medtronic 670G with the Guardian CGM as well as the Dexcom G5 CGM and the Libre Freestyle CGM. 

We were stuck between the OmniPod and the Tslim for the functionality and user friendliness as well as the Dexcom G5 for the CGM.  We took all of their information home to read over and were told the sooner we could make a decision the better because it would probably take our insurance 2 months or more to get an approval and training was booked out until October.  Abbie was sent home with a “trial” infusion set of the Tslim in her arm to wear for 3 days to give her an idea of what it felt it like to insert one and wear one.  Over the next week we read over the information together and ultimately settled on the Tslim because of the looks, the functionality, user friendliness, and the compatibility with the Dexcom.  By the end of July I had called the CDE and told her which pump and CGM we had opted for and filled out all the necessary paperwork.

The pump process was fairly simple once we found out we couldn’t go directly through Tandem and had to go through a third party supplier called EdgePark. I was a little concerned because most people have issues with Edgepark, but honestly, to this day I have had no issues with them and their customer service has been great with me.  Edgepark said we would receive the pump probably by the middle of September and our training was scheduled for October 2nd, so I was okay with that.  We only had 30 days from time we received the pump to make sure it was the one for us, so I wanted to make sure we had some time to use it. 

Now on to the CGM process.  To me a CGM is WAY more important than a pump and should be given when a person leaves the hospital.  However, apparently an insurance company does not see it that way.  Dexcom told us, like Tandem did, that we would need to go through a third party provider and it was of course EdgePark.  I made sure Edgepark had all of the necessary information including the prescription, logs, doctor information and anything else they would need for the insurance.  About a week later, they called and said Abbie had been denied and that the doctor would be allowed a peer to peer review or I could start an appeal.  When I called Anthem asking more questions, I was informed that my daughter did not have enough lows to justify a CGM and that they needed proof that she was having lows below 50 in the last 3 months!  50 I thought, 50?  We had worked so hard with so many finger sticks to make sure she didn’t fall that low and now we were being chastised because of it.  I felt an anger that I couldn’t hardly contain. 

Over the next 2 months everything that could go wrong did.  The review process has to be done in a certain amount of time.  When I tried to contact her primary Endo, he was out of the country until way after the time was up and Anthem did not want to extend the review for any reason.   I remember getting on the phone with Abbie’s Anthem nurse specialist and just breaking down and crying, explaining my case.  She made some calls and got them to approve to hold off the review until after he returned from out of the country.  Also, around the middle of August I got a big package in the mail, guess what it was?  Yep, the Tslim. 

So, I called the CDE hoping to get into training a little bit sooner but she had nothing until October 2nd.  So here we were with a pump that was going to be out of the return policy before we even got to use it. But ok, whatever, I thought we had done enough research we would be ok with this pump.  Abbie loved it and it was her decision.

Now, I am not sure how familiar you guys are with Tslim, but it can only be used with Novolog or Humalog and I knew my insurance was going to give me a fit about that insulin because they had tried when Abbie was first put on fast-acting back in June, which is why we were on Apidra.  So I had gotten that process started at the beginning of August to make sure by October it was settled. 

Periodically I would call my pharmacy to make sure they had the prescription and they did they were just waiting on the pre-authorization and the approval from the insurance.  I would then call the doctor’s office to make sure the pre-authorization was done, which it had been.  Fast forward to about 2 weeks before the pump training and I still had not received a call from the pharmacy that the prescription was ready, so I called.  Now they informed me that the insurance denied me because they were saying it was an overdose of insulin.  Well I had had enough!  Something came over me and the poor person that answered the phone at Anthem that day got drew the short end of the stick.  I ended up on a 4 way conference call with the customer service agent, my Endo, and the pharmacist.  I had a full 6 month prescription ready in the next hour.  Now if only I could get the Dexcom approved that easily… we were still working on that. 

The day of pump training finally arrived and I had read the manual from front to back with Abbie.  We walked into the CDE’s office and we were very prepared.  She told us she had set aside 2-3 hours for training.  We figured out her basal rates, carb ratios, target blood sugar, and correction factor.  We set up one program for now and she showed us how to load a cartridge and put on the infusion set.  Our training took about an hour.  I remember our CDE going to get the Endo before we left because she said he wanted to discuss a couple of thing with me.  A few minutes later in walked the doctor with our food logs.  “Mrs. Eger, you are still not feeding Abbie enough carbs for healthy development.” I just looked and smiled; I refused at that moment to argue and asked if he had anything else.  I asked him about the target numbers he gave at 150 for the daytime and 180 at night as they seemed high to me.  He informed me that for her age until she was probably in high school or older, she needed to maintain these numbers to thrive and to not be on dangerous levels.  Ok, I thought, what do I know.

So off we went, home with our new pump.  Anxiously waiting on our Dexcom.  I knew once we got that piece of equipment combined with the pump, everything would change for the better.  Just for reference, at this appointment Abbie’s A1C was 8.8.

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