Insurance help

So last night I got home to a $947.00 bill from my endocrinologist. My insurance doesn't want to pay it since it was for my time meeting with the CDE about the CGMS.

I need help. I feel like there is an efficient and effective way to talk to insurance companies about this and I haven't the slightest idea how to do it. Do I just call in? Do I write a letter? Do I call and write? Do I call my doctor and have them call the insurance company? Do I have my doctor write a letter about the necessity? I looked on JDRF's site and found nothing of this sort.

I work for a non-profit. I'm so very close to paying off my hospital stay... from two years ago. I don't make enough money to pay this off and REALLY don't want to. I realize that the insurance company may not pay for it in the end anyway, but I'd like to do all I can to try. Please give me any and all advice you have!

Thanks.

Two years today.

Jumping on the bandwagon: Hypos without Symptoms!

It's not really bandwagon I wanted to jump on, but there it is. After reading Kerri's scary post I decided to post about my recent (albeit not nearly as low or eventful) hypo without symptoms.

This past weekend I was in Minneapolis with my boy. We had gone out for a couple drinks with friends on Friday night after a quick bit to eat. We get back to his apartment and decided that leftovers sound perfect. We share half of my left over quesadilla while chatting. About an hour later we're both ready for sleep and I grab my meter to do the before sleep check. 44. Huh? I almost check it again before I realize that there's not much time for rechecking, even though I FEEL NOTHING. I tell him I need some juice to drink, and we both head to the fridge to forage for a sugar filled liquid. I grab a capri sun and drink. I'm sitting on his bed, tears streaming down my face, eating a peanut butter cracker, with him sitting next to me trying to comfort me, more bewildered than anything.

Since we are in a long distance relationship, he hasn't ever seen me in a panicky low situation. And this was especially panicky for me since it was my first hypo without symptoms. I'm not too worried about it now, but if it happens again I will be.

In other news, I just got a note from my insurance company that they aren't going to cover a $1,000 bill from my endocrinologist. It was from the appointment I had with my CDE about testing out the CGMS. Both her and I assumed that they would reject covering the two sensors, but not the appointment cost. I've yet to get a bill from her though, so I hope she's trying her hardest to hassle them into payment. Otherwise... I don't know. I should start playing the lottery.

Finally, in happy news, I went on a 3 mile run around a beautiful lake in Minneapolis with my boy on Saturday morning. I'm offically ready for my first 5k at the end of April!

Numbers

I had my endocrinologist appointment today. I brought in the Guardian, already back to finger pricks after the sensor died Sunday morning.

My overall experience with the Guardian was good. It was great. I really enjoyed seeing what my blood sugar did after eating different things. Turns out I had a better time controlling it after eating a big bowl of cold stone ice cream with Chris in Minneapolis than I did after eating a 6 inch whole wheat sub from Subway. I discovered that my blood sugar sometimes RISES while I work out.
Before I just thought that if it was higher after working out I’d eaten too many carbs some how and got my blood sugar too high. No no no. Saturday I worked out (hard!) without eating anything before hand. I had my bottle of Gatorade at my side and the Guardian on the machine and I just watched it clime. 103, 108, 115, 123, 130! I had no idea.

I didn’t enjoy the random alarms during the night because the sensor ‘lost’ the transmitter. I didn’t enjoy the giant strips of tape that had to cover the sensor so as to keep it dry. I didn’t enjoy having the pump AND the sensor/transmitter on my body at the same time. I also became a bit… anal, about checking my blood sugar. But I couldn’t help it! Ten minutes into a meal, why not just push a button and see what’s happening?

So, back to this morning. I brought it into my doctor and my CDE downloaded the information for me to review with the doctor. It was great. We changed a couple bolus ratios and one basal rate, but everything else was great. He was happy. I was happy. Then we went over my lab results. My a1c dropped a little (yay!).

Then there was the ‘4’. Under TSH. Thyroid. My mother has been taking hypothyroid medicine since her early 20s, so it’s in the family. And now I’ve got the ‘betes, which goes hand in hand with thyroid problems. Apparently the old guidelines say that if it’s 5 or over, then I’ve got hypothyroidism and need to take a pill to add some thyroid hormone to my body to combat the symptoms of fatigue (hmm), weight gain (not me, somehow!), and other things (memory loss, slow reactions etc). My doctor likes to play things safe so I went and had some more blood drawn to do another test. When it comes back, he’ll let me know if he recommends a pill to replace some of the thyroid hormone.

Amazingly, I feel great. I had such a good diabetes evaluation that this hypothyroid problem seems like nothing. And really, one pill a day compared to what I do for the ‘betes? No problem.

But for now I’ll wait to see what that number comes up as on Wednesday.

Also, for those of you considering the Guardian, I had a couple questions that I had to call into Minimed for and they were answered wonderfully. Great support. In addition, my doctor mentioned that some people think of buying the Guardian ($2,700) and then using it only intermittently, when there blood sugars are doing crazy things. So instead of using it full time ($400 a month for sensors), you could use it half the time and only spend $200 a month. He also said that the sensors actually last longer than 3 days… you just have to know the trick to tell your meter to keep going! Didn’t mention how long it would last with the trick.

Fasting

The great thing about this machine is that I can easily test my basal rates. My doctor told me to test for all times of day: night, morning, day time, dinner time. So, yesterday I fasted from 5:00 pm to 6:00 am this morning. Working at my part time job last night, smelling the fried chicken and apple pie that was made... Oooh. That was hard. I took a piece of pie home and will eat it tonight. I'll even tell my doctor that I really wanted to KNOW what happens when I eat pie! Anyway, I made it through my fasting and my blood sugars were fabulous.

Today I'm skipping lunch. So far, so good, but it's only 12:25. I ate breakfast at 6:30. I'll eat a snack before the gym around 5:30. Tomorrow I'll skip dinner (breaking fast around 10 at night) and Friday no breakfast.

I also have to eat meals with exact carbohydrate counts to make sure my bolus rates are correct. Basically, I'm doing a lot of things I normally WOULDN'T do, but it seems necessary. I'll still get a few of my normal meals in there to get an idea of what my blood sugar does during those times (um, dark chocolate anyone?).

Julia, you asked why I would only wear this for 6 days. What happened is that I went to my endocrinologist at my last appointment 3 months ago and mentioned that I was interested in wearing the older constant glucose monitors. I don't know much about these except that you can't check your blood sugar in real time, you only down load it at a later date and look back at it. Anyway, my doctor mentioned that he had a Guardian and that I could use that. My main goal was to see what my blood sugar was doing during all times of the day, eating different foods, during different activities etc. It just happened that I got to use this brand new technology. Brand new EXPENSIVE technology that my insurance won't cover. So that is why I'm only wearing this for 6 days, because it's my doctors and I can't afford one of my own.

That said, if someone gave me one today with free supplies, I'd make use of it, if not wear it everyday. It's still pretty big and cumbersome (for me anyway).

I'm going to go think about what I'll eat for dinner now... besides that pie. :)

No idea

After one day of use I have to say this: I had no idea my blood sugar reacted in this way.

For instance: Yesterday for lunch I went out with a co-worker for her birthday. I got a chicken avocado club sandwich with a side salad. Total carbs guestimated at 40. I bolus, eat, and watch my blood sugar. At first it starts going lower (from 120 to 105) and then, about 45 minutes after eating, it starts to rise. It continues to rise up to 156 at the two hour mark. In my head, if my blood sugar was at 156 two hours after eating I would just assume that it had been even higher for the previous hour or two. In some cases this is true, in others, obviously, it's not. I just had no idea.

One difficulty I'm finding is that while I'm watching my blood sugar rise after eating, it's so HARD to wait the two hours to see what it will end up at. I want to start corrected right away when I see it at 170 or so, even though after the requisite two hours it might well go back down to 120 or 100 even. It's hard not to jump the gun.

While this thing is currently the best of the best, it isn't terribly small. If I tried to wear any form fitting shirt I'd have a very noticeable bump. But, for the next 5 more days, I don't give a shit about that. I can deal with the inconvenience because the benefits are pretty amazing.

Hooked up

I’m hooked up. This morning I braved the fierce rain and wind and made it to my endocrinologist’s office by 8:00 a.m. My diabetes educator, Sue, brought me back to her office. For about 20 minutes she showed me the apparatus in all its pieces. I quickly learned how to insert the $40 sensor (carefully!) and after an hour, with instructions on how to calibrate it in 2 hours and 20 minutes, I was off.

For the next 6 days I’ll be wearing/using a Guardian.



My initial reaction is: cool! I’m so excited to see what my blood sugar is doing during the night when I’m asleep or what it does after I eat a cookie compared to a whole grain bowl of cereal. My second reaction is: damn, my stomach sure is crowded now. Seriously. My pump is currently on the right side and the sensor and transmitter is on my left. I feel like I need a utility belt today to carry my pump and this meter. But I don’t care!

So this week will involve a lot of fasting to check my night, evening, morning and day time basal rates. It will also involve a lot more record keeping than normal. (Normal being none at all). I’ll record every bit of food and insulin I take. I’ll record when I exercise and for how long. I’ll even record when I eat those frowned upon foods, because I eat those normally, so I want to know what my body is doing during that two hours afterwards.

I feel like a kid with a new toy. Want to know what my blood sugar is right now? 113! Before that? 110. And before THAT? 107, 104, 102 (in five minute increments).

Stay tuned…