Continuous glucose sensors are a remarkable tool and can provide both the patient and the physician significant insight to what the patient’s glucose is doing in between patient checks. Furthermore, the devices can be set so that the patient receives an alert before the serum glucose levels are exceedingly high or low.
Continuous sensors detect the amount of glucose in the subcutaneous fluid. They do not do away with finger stick monitoring altogether, but even if patients are checking 6 to 8 times a day, a lot can happen between checks. Sometimes, you can determine that the patient has some mild gastroparesis because the rise in glucose occurs late after meals. Some patients have unrecognized nocturnal hypoglycemia. Patients with hypoglycemia unawareness can especially benefit from the alerts the sensor systems provide.
Many commercial plans will pay for a sensor system. It is generally easier to get approval for patients with type 1 diabetes, but many insulin-requiring type 2 patients can get coverage as well. The problem is that Medicare does not cover the device at all. My patients and I find this very disconcerting. For one thing, if a patient has commercial insurance and then reaches Medicare age, they have to give up their sensors. More importantly, it is the older patient who is more at risk of the deleterious effects of hypoglycemia and would therefore greatly benefit from the hypoglycemia alarms. Most of these patients have multiple medical issues as well, and being able to avoid extreme excursions can help prevent hospitalizations and emergency room visits.
I have been told there are rare cases – that involve repeated appeals as far up as Federal Court – in which a sensor system has been approved for a Medicare patient. I would imagine, however, that most practices, such as my own, do not have the time or resources available to dedicate to such appeals. I have also been advised to ask my patients to contact their congressional representatives, as it will take a change in law to get the items covered. Well, that will be great some day, but for my patients who need sensors now, that is of little comfort to them.
The American College of Endocrinology and the American Diabetes Association both recognize the benefit of these devices. Granted, they are not for everybody and not every diabetic patient needs one. It is, however, my hope, and that of my patients, that the continuous glucose sensor will someday be recognized by the Centers for Medicare & Medicaid Services as the potential life-saving device it is.
Please share your experiences below. Have you been able to successfully appeal a denial of coverage?