January 27, 2007
Question from Youngstown, Ohio, USA:
I have a question regarding the new Medtronic insulin pump with the blood sugar monitor. My daughter will be switching from four to five daily injections to the new Medtronic pump in a few weeks. We were very excited about this until we were told that the optional blood sugar monitor (and blood sensor supplies) are not covered by either Blue Cross or Medicaid. We were told that the blood sugar monitor is $1000.00 out of pocket and the supplies will run approximately $350.00 per month out-of-pocket, neither of which we can afford. Do you have any idea why the blood sugar monitor itself wouldn’t be covered through either Blue Cross or Medicaid and if it might be covered at some point?
Your situation poses a difficult question: Why don’t publicly funded medical care programs provide access to the newest technology in the treatment of diabetes? I do not have an answer other than to say the state Medicaid program and the SCHIP program (Blue Cross) are allowed to establish coverage limitations such as formularies, preferred DME providers and cost containment caps. These programs are also permitted to establish pre-certification requirements before they will authorize treatment with insulin pump therapy. This means that your daughter’s physician must assist you in showing that this treatment fits within their guidelines. While I am not a medical professional, the literature indicates that there are several brands and models of insulin infusion pumps that are in wide use. You should contact the Medicaid or SCHIP carriers to determine which one they will cover. In my humble opinion, sticking to the treatment plan that will help your daughter while staying within the coverage requirements will benefit the family in the long run. This course of action may be a better route rather than to pursue treatment with a device that your family cannot afford.