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November 24, 2004

A1c (Glycohemoglobin, HgbA1c), Insurance/Costs

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Question from Newbury Park, California, USA:

My daughter is now checking her own A1c with the home test kit available from Diabetic Express. We check it the day before she goes to her three month check-up with her pediatric endocrinologist. It’s inexpensive ($25 each one time use), quick, accurate and easy. No longer does she have to submit to a blood draw or try to find a hospital or clinic with the proper equipment to run the test. A single finger prick and a few drops of solution and the results are ready in eight minutes!

My problem is that Blue Cross insurance refuses to cover the cost of the kit. Even though it is saving the insurance company money and is so much less traumatic for my daughter, they say it is “investigational” and won’t cover this equipment. I refuse to submit my daughter to a blood draw every month for this test. It’s an ordeal to begin with as she is always worried about the results. I’ve already filed an appeal and lost. I was just wondering if you had any suggestions/experience in this area and wonder why it takes insurance companies so long to keep up with technology?

Answer:

From: DTeam Staff

Full disclosure: I am employed by an HMO licensed in California

While you blame the health insurance industry for being behind the curve, the industry follows the lead of the largest purchaser of health care services, the Medicare program. At this time, Medicare has not approved the home A1c test for reimbursement. Generally CMS, the federal agency the administers the Medicare program, is very wary of home testing for reimbursement. They are concerned about fraud and abuse issues as well as the fact that the people doing the testing are untrained. While CMS recognizes the value of A1c testing, they will not reimburse for such testing outside of the physician or medical laboratory setting. Until CMS approves this type of at-home testing, it is very unlikely that such testing will be paid for by health insurance. If you find value in avoiding the type of testing that is reimbursed by your health insurer, then perhaps you should consider that money well spent. By the way, check with your tax advisor to learn if home A1c tests can be paid for with funds from your health savings account (HSA).

DSH

[Editor’s comment: You may want to find out if your daughter’s endocrinologist uses a Bayer DCA 2000 device, which provides A1c values in six minutes from one drop of capillary blood obtained via a finger stick.

BH]