Today I received a note from my employer’s insurance broker. They are trying to help me get insurance coverage of an insulin pump and continuous glucose monitor system.

Attached was the criteria Great West uses to decide who gets coverage and who does not.

Policy: Criteria #1
A. Continuous subcutaneous insulin infusion (CSII) with an external insulin pump, including OmniPod®, is considered medically necessary and is covered as durable medical equipment (DME) when all the following are met:
1. The patient has very low endogenous insulin levels as demonstrated by the fasting C-peptide requirements* as defined below OR is beta cell autoantibody positive (Levels only need to be documented one time in the medical record), unless there is an unequivocal history of diabetic ketoacidosis (DKA)

Very low endogenous insulin levels are a diagnosis of Type 1 diabetes, not Cystic Fibrosis Related Diabetes.

Beta cell autoantibody positive would lead to a diagnosis of Type 1 diabetes, not Cystic Fibrosis Related Diabetes.

DKA is not common in patients with Cystic Fibrosis Related Diabetes. (thank goodness for me!)

I do NOT HAVE TYPE 1 DIABETES!…. is there ever an exception to the rule?!!!

As if I didn’t have enough to deal with already, why won’t my insurance realize that not everyone fits in their little square box of “average”?!

To continue on…

Here is the policy of who receives coverage for a continuous glucose monitor:

“The combination insulin pump and continuous blood glucose monitoring system is covered when the cost of the combination device is not greater than the cost of the pump alone”

I am in disbelief… did I read that right?! Insurance will pay for a CGMS only if it is FREE?! WHY WOULD I NEED COVERAGE IF IT WAS FREE?!!!

The logic is not making any sense to me today… sigh.