[An update/resolution to this post can be found here.]
"I have heard there are troubles of more than one kind
Some come from ahead, some come from behind
But I've bought a big bat, and I'm all ready, you see
Now my troubles are going to have troubles with me"
- Dr. Suess
It hadn't really occurred to me that obtaining a new insulin pump to replace my soon-to-be-out-of-warranty one would be a challenge. Based on my past experience, I figured that filling out all of the paperwork would be the most difficult part of the process (and God laughed): the warranty on my Animas Ping expires at the end of this month, so of course I need a new one. The pump's housing is quite scratched up, and the buttons are not as responsive as they once were. The pump's technology is now at the very least five years old (FDA approved the Ping system for sale in July of 2008), and doesn't have many of the features that newer pumps offer patients.
Except that Cigna and Care Centrix (my insurance and DME providers) don't seem to agree.
For a company that says they are "dedicated to helping people improve their health, well-being and sense of security", I'm sure not seeing it. Using a medical device that's endured four years of use and (inadvertent) abuse is going to help my "sense of security"? Do you know how many times this pump has been dropped, knocked around, or been exposed to snow and below-freezing temperatures? It's the nature of wearing a medical device 24/7 for four years. It's normal wear-and-tear.
This process started with me filling out patient info forms with both Tandem and Asante (figuring that since Animas was already approved for me, I didn't need to pursue that route), and my doctor faxing over the needed signatures and documents. It's been a few weeks since we did that, and an insurance verification rep from Tandem and I have been emailing back and forth periodically throughout the process (asking when my current pump was purchased, if it was still in warranty, etc.). When I answered that my pump was purchased in December of 2009, the rep responded positively. "Great news", she said.
And I thought it was, too.
Except that her follow-up email said this:
I also want to point out that the Cigna employee used the phrase "entitled to" when referencing my ability to obtain a medical device that makes a huge difference in how I am able to manage my health.
I took to Twitter.
This process started with me filling out patient info forms with both Tandem and Asante (figuring that since Animas was already approved for me, I didn't need to pursue that route), and my doctor faxing over the needed signatures and documents. It's been a few weeks since we did that, and an insurance verification rep from Tandem and I have been emailing back and forth periodically throughout the process (asking when my current pump was purchased, if it was still in warranty, etc.). When I answered that my pump was purchased in December of 2009, the rep responded positively. "Great news", she said.
And I thought it was, too.
Except that her follow-up email said this:
"Just got off the phone with CareCentrix. Per CCX the expiration date does not warrant a new pump. They state the current pump most be malfunctioning or not meeting your medical needs."I responded by telling her about the pump being scratched up, and the buttons not working consistently.
"The only way we can get this approved is if we could show your A1C’s being effected by the current pumps malfunctions. Looks like your last A1C’s were in the 6’s which would be considered manageable. We may have to wait until the warranty is up on the pump and the functionality is no longer meeting your medical needs."Expressing my disappointment, I told the Tandem rep that I'd be contacting Cigna. She added that she was very surprised to find out that Cigna does not have an automatic approval policy for a new pump when the old one is out of warranty - to her knowledge, they are the only carrier with that policy.
I also want to point out that the Cigna employee used the phrase "entitled to" when referencing my ability to obtain a medical device that makes a huge difference in how I am able to manage my health.
I took to Twitter.
I will not cry at work. I will not cry at work. Cigna/CareCentrix won't cover new pump unless my A1Cs show adverse health from current one.
— Kim / Diabetes (@txtngmypancreas) December 6, 2013 I am crushed.
— Kim / Diabetes (@txtngmypancreas) December 6, 2013 So let me get this right - because I am too healthy, I will continue to use inferior technology. This is so backwards.
— Kim / Diabetes (@txtngmypancreas) December 6, 2013 So they're waiting until my health is negatively affected to cover better treatment options? Way to be proactive, @Cigna.
— Kim / Diabetes (@txtngmypancreas) December 6, 2013And then, a ray of sunshine:
@txtngmypancreas Kim, I would like to try and help you get this resolved, can you please email me at LetUsHelpU@Cigna.com? Thank you.
— Customer Service (@Cignaquestions) December 6, 2013You bet I'll email you. R2? Fire up the converters!
Because the thing is - it's great that I have an insulin pump already, and I'm thankful for it. It is one tool among many that has helped me attain what is apparently the only criteria that Cigna cares about - a "good" A1C result.
What Cigna fails to factor into their judgement here is that A1C isn't actually a great summarization of my diabetes management - it simply provides an average. It doesn't factor in standard deviation of glucose values, it doesn't predict the chances of me developing complications, and it certainly doesn't relieve any of the cognitive burden of managing this disease all day, every day. My A1C doesn't tell them how I attained that result.
And what Cigna/CareCentrix also fails to recognize is that part of the reason I'm okay NOW is that I have been able to use the best of what's available NOW. If you want me to continue to be healthy in the future, I need to be able to use the best of what's available in that future. "You're doing okay with what you're using" is the exact argument FOR a new device being approved. Let's make sure I keep doing okay.
What this boils down to is really simple - Cigna/CareCentrix can either pay for a new insulin pump now (because that is the treatment option that is most effective for me, given what's currently available), or they can wait until I've experienced any number of adverse health outcomes that result when this old insulin pump malfunctions and pay for any resulting hospital charges. Show me where that fits into their mission statement of "helping people improve their health and well-being".
Do I sound dramatic? Good. This is my life and my health we're talking about, and I take that health very seriously. Give me the tools I need to help me be healthy, and it will save you money in the long run, Cigna. If the technology is there, let me use it.
Let all of us use it. This isn't just about one person with some degree of social media influence fighting for what she needs - this is about every person having access to what can help them achieve good health. This is about all of us, and moral issues aside, it's to a payer's financial benefit that their customers have access to the baseline preventative care they need.
I will write whatever needs to be written; show whatever needs to be shown; speak with whomever needs to be spoken with; do whatever needs to be done. Their policy is wrong, and I'll be happy to tell them exactly why.
(Where things stand as of this posting: Cigna has spoken with CCX and the request is being looked at again. I'm working with my endo's office to get CCX whatever proof they need to get a new pump authorized and covered.)
"Sir, the possibility of successfully navigating an asteroid field is approximately 3,720 to 1." - C-3PO
"Never tell me the odds." - Han Solo
No comments:
Post a Comment