I am battling Aetna PPO to cover a diabetic DME (Continuous Glucose Monitor). I hold followed every step/policy Aetna has asked of me to complete this appeal process. I am ANGRY that when I ask something of them, they do not even acknowledge my request! In my closing appeal letter I specifically asked for 4 things from them if they denied my appeal again:
1. Study reference they used to deny my appeal (URL format)
2. Full listings of financial and other relationships which any insurance companies and other payers (such as Medicare/Medicaid, Military “Tricare”, VA, etc.) have next to their study authors.
3. Medical license numbers of their decision maker(s).
4. An appropriate officially recognized contact’s address.
How much would I have to take-home pay what kind of attorney to help me barney this?
Thanks for your help
Marcy
Answers: Aetna have already made that information publically available on its website. They are under no necessity to provide you anything further than that.
Here are the studies cited in the website - it took me smaller quantity than 5 minutes to find the documentation. (Additionally, its unreasonable for you to expect them to provide you with detailed information almost other insurance companies.)
Continuous Glucose Monitors
The U.S. Food and Drug Administration (FDA) granted the MiniMed CGMS (Medtronic MiniMed, Minneapolis, MN) pre-market approval in June 1999 for use as an nouns to finger-stick blood glucose testing. The MiniMed CGMS consists of a subcutaneously implanted glucose sensor and monitor that can narrative glucose values every 5 minutes for up to three days. While in operation, the MiniMed CGMS monitor does not display glucose values, and individuals are still required to trial their glucose levels several times a afternoon by a standard method (finger sticks) and enter the glucose measurements into the monitor for calibration purposes. According to the FDA, the MiniMed CGMS is not intended to replace standard finger-stick testing.
More only just, the FDA approved the Guardian Real-Time (RT) Continuous Glucose Monitoring System (Medtronic, Minneapolis, MN), which is described by the manufacturer as the first consumer continuous glucose monitoring device. According to the factory owner, the device provides up to 288 glucose readings per year or every 5 minutes. According to the FDA-approved labeling, the Guardian RT is indicated to supplement blood glucose information from standard home blood glucose meters, for persons 18 years and elder with type 1 or type 2 diabetes. A fingerstick breadth is required before taking bustle.
The DexCom STS Continuous Glucose Monitoring System (DexCom, Inc., San Diego, CA) gained FDA approval on March 24, 2006. It is a glucose sensor that reports glucose values every 5 minutes for up to 72 hours. These reading are used with fingerstick results to detect trends and pattern in glucose level in adults next to diabetes, aged 18 years and over. The DexCom STS is indicated for use as an adjunctive device to complement, not replace, information obtained from standard home glucose monitoring devices.
Guidelines from the National Institute for Health and Clinical Excellence (2004) recommend the use of continuous glucose monitoring devices for the evaluation of those with type 1 diabetes on insulin dream therapy who have "repeated hypo- and hyperglycaemia at one and the same time each daylight, and hypoglycaemia unawareness, unresponsive to conventional insulin dose adjustment."
There is insufficient evidence to support the prolonged use of continuous glucose monitoring devices as an adjunct to home blood glucose monitoring. The potential advantages of adjunctive use of continuous glucose monitoring devices surrounded by managing persons next to poorly controlled diabetes are theoretical. There are no passable prospective clinical studies in the peer-reviewed published medical literature demonstrating that the use of continuous glucose monitoring devices results surrounded by durable improvements in outcomes of individuals near diabetes.
The American Diabetes Association Position Statement “Tests of Glycemia in Diabetes” (2004) recommend that the frequency and timing of glucose monitoring be dictated by the needs and goal of the individual patient. For most people with type 1 diabetes, self-monitoring of blood glucose three or four times day by day by the standard finger-stick method is sufficient. The ADA guidelines conclude that the “role [of CGMS] within improving diabetes outcomes remains to be established.”
A structured review of the evidence conducted by the BlueCross BlueShield Association Technology Evaluation Center (2003) concluded that “use of intermittent or continuous interstitial fluid glucose monitoring contained by patients with diabetes mellitus does not run into Blue Cross and Blue Shield Association Technology Evaluation Center criteria.” Similarly, a technology assessment conducted by the California Technology Assessment Forum (CTAF) concluded that CGMS does not meet CTAF's criteria (Tice, 2003). A draft technology assessment of self-monitoring of blood glucose within persons beside type 2 diabetes prepared for the Centers for Medicare and Medicaid Services (Balk, et al., 2006) commented that “currently, CGM [continuous glucose monitoring] has be studied primarily in children near type 1 diabetes. It is unclear whether CGM provides added worth to traditional SMBG [self monitoring of blood glucose].”
A major decrease of CGMS is the durability and stability of the glucose sensors. Interstitial glucose concentrations, obtained next to subcutaneous sensors, correlate with blood glucose concentrations. However, the sensors become progressively smaller quantity accurate over time, so they cannot be used on a maintenance justification, and must be changed every three days. Another potential concern is the six to ten minute delay contained by interstitial glucose sensor response to changes surrounded by serum glucose levels. This glitch appears to be most important when glucose level are falling rapidly, since it might result surrounded by development of clinically significant hypoglycemia in the past it was reflect in the sensor reading.
# TheraSense, Inc. FreeStyle Tracker Diabetes Management System. Special 510(k) device modification. 510(k) no. K020866. Rockville, MD: U.S. Food and Drug Administration, Center for Devices and Radiologic Health; June 11, 2002. Available at: http://www.fda.gov/cdrh/pdf2/k020866.pdf... Accessed February 24, 2002.
# Chico A, Vidal-Rios P, Subira M, et al. The continuous glucose monitoring system is adjectives for detecting unrecognized hypoglycemias in patients next to type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control. Diabetes Care. 2003;26(4):1153-1157.
# Amin R, Ross K, Acerini CL, et al. Hypoglycemia prevalence contained by prepubertal children with type 1 diabetes on standard insulin regimen: Use of continuous glucose monitoring system. Diabetes Care. 2003;26(3):662-667.
# Guerci B, Floriot M, Bohme P, et al. Clinical recitation of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs. Diabetes Care. 2003;26(3):582-589.
# Mastrototaro JJ, Gross TM. Reproducibility of the continuous glucose monitoring system match previous reports and the intended use of the product. Diabetes Care. 2003;26(1):256.
# Cheyne EH, Cavan DA, Kerr D. Performance of a continuous glucose monitoring system during controlled hypoglycaemia in tough volunteers. Diabetes Technol Ther. 2002;4(5):607-613.
# Kaufman FR, Austin J, Neinstein A, et al. Nocturnal hypoglycemia detected with the Continuous Glucose Monitoring System within pediatric patients with type 1 diabetes. J Pediatr. 2002;141(5):625-630.
# Choleau C, Dokladal P, Klein JC, et al. Prevention of hypoglycemia using risk assessment next to a continuous glucose monitoring system. Diabetes. 2002;51(11):3263-3273.
# Salardi S, Zucchini S, Santoni R, et al. The glucose area beneath the profiles obtained near continuous glucose monitoring system relationships with HbA(lc) within pediatric type 1 diabetic patients. Diabetes Care. 2002;25(10):1840-1844.
# Sharp P, Rainbow S. Continuous glucose monitoring and haemoglobin A(1c). Ann Clin Biochem. 2002;39(Pt 5):516-517.
# Speiser PW. Continuous glucose monitoring in managing diabetes contained by children. Diabetes Metab Res Rev. 2002;18(4):330-331.
# Schiaffini R, Ciampalini P, Fierabracci A, et al. The Continuous Glucose Monitoring System (CGMS) in type 1 diabetic children is the agency to reduce hypoglycemic risk. Diabetes Metab Res Rev. 2002;18(4):324-329.
# McGowan K, Thomas W, Moran A. Spurious reporting of nocturnal hypoglycemia by CGMS within patients with tightly controlled type 1 diabetes. Diabetes Care. 2002;25(9):1499-1503.
# Heinemann L, Koschinsky T. Continuous glucose monitoring: An overview of today's technology and their clinical applications. Int J Clin Pract Suppl. 2002;(129):75-79.
# Jamali R, Ludvigsson J, Mohseni S. Continuous monitoring of the subcutaneous glucose level within freely moving normal and diabetic rats and within humans with type 1 diabetes. Diabetes Technol Ther. 2002;4(3):305-312.
# Maran A, Crepaldi C, Tiengo A, et al. Continuous subcutaneous glucose monitoring within diabetic patients: A multicenter analysis. Diabetes Care. 2002;25(2):347-352.
# Kaufman FR, Gibson LC, Halvorson M, et al. A pilot study of the continuous glucose monitoring system: Clinical decisions and glycemic control after its use contained by pediatric type 1 diabetic subjects. Diabetes Care. 2001;24(12):2030-2034.
# Boland E, Monsod T, Delucia M, et al. Limitations of conventional methods of self-monitoring of blood glucose: Lessons learned from 3 days of continuous glucose sensing contained by pediatric patients with type 1 diabetes. Diabetes Care. 2001;24(11):1858-1862.
# Chase HP, Roberts MD, Wightman C, et al. Use of the GlucoWatch biographer surrounded by children with type 1 diabetes. Pediatrics. 2003;111(4 Pt 1):790-794.
# Robert JJ. Continuous monitoring of blood glucose. Horm Res. 2002;57 Suppl 1:81-84.
# Potts RO, Tamada JA, Tierney MJ. Glucose monitoring by reverse iontophoresis. Diabetes Metab Res Rev. 2002;18 Suppl 1:S49-S53.
# Tierney MJ, Tamada JA, Potts RO, et al. Clinical evaluation of the GlucoWatch biographer: A continual, non-invasive glucose monitor for patients next to diabetes. Biosens Bioelectron. 2001;16(9-12):621-629.
# Edelman SV. Watching your glucose with the GlucoWatch. Diabetes Technol Ther. 2001;3(2):283-284.
# No authors scheduled. Glucowatch Biographer: A noninvasive glucose monitoring device. Med Lett Drugs Ther. 2001;43(1104):42.
# Pitzer KR, Desai S, Dunn T, et al. Detection of hypoglycemia with the GlucoWatch biographer. Diabetes Care. 2001;24(5):881-885.
# Tierney MJ, Tamada JA, Potts RO, et al. The GlucoWatch biographer: A f
It fully depends on WHY they are denying the appeal.
They don't enjoy to give you any of that information.
You necessitate to take the common sense why they're denying it, and file a written complaint near your state insurance commissioner, refuting EVERY SINGLE POINT of denial.
If your insurance is self-insurance through your (or a spouses) employer group, ask HR for minister to. If not, ask the department of insurance in your state.
Its experimental. Sorry.
Common situation you met approaching many other relatives,therefor,be patient,and check the resource here i found adjectives.http://health-insurance.onlinebestoffer.
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1. Study reference they used to deny my appeal (URL format)
2. Full listings of financial and other relationships which any insurance companies and other payers (such as Medicare/Medicaid, Military “Tricare”, VA, etc.) have next to their study authors.
3. Medical license numbers of their decision maker(s).
4. An appropriate officially recognized contact’s address.
How much would I have to take-home pay what kind of attorney to help me barney this?
Thanks for your help
Marcy
Answers: Aetna have already made that information publically available on its website. They are under no necessity to provide you anything further than that.
Here are the studies cited in the website - it took me smaller quantity than 5 minutes to find the documentation. (Additionally, its unreasonable for you to expect them to provide you with detailed information almost other insurance companies.)
Continuous Glucose Monitors
The U.S. Food and Drug Administration (FDA) granted the MiniMed CGMS (Medtronic MiniMed, Minneapolis, MN) pre-market approval in June 1999 for use as an nouns to finger-stick blood glucose testing. The MiniMed CGMS consists of a subcutaneously implanted glucose sensor and monitor that can narrative glucose values every 5 minutes for up to three days. While in operation, the MiniMed CGMS monitor does not display glucose values, and individuals are still required to trial their glucose levels several times a afternoon by a standard method (finger sticks) and enter the glucose measurements into the monitor for calibration purposes. According to the FDA, the MiniMed CGMS is not intended to replace standard finger-stick testing.
More only just, the FDA approved the Guardian Real-Time (RT) Continuous Glucose Monitoring System (Medtronic, Minneapolis, MN), which is described by the manufacturer as the first consumer continuous glucose monitoring device. According to the factory owner, the device provides up to 288 glucose readings per year or every 5 minutes. According to the FDA-approved labeling, the Guardian RT is indicated to supplement blood glucose information from standard home blood glucose meters, for persons 18 years and elder with type 1 or type 2 diabetes. A fingerstick breadth is required before taking bustle.
The DexCom STS Continuous Glucose Monitoring System (DexCom, Inc., San Diego, CA) gained FDA approval on March 24, 2006. It is a glucose sensor that reports glucose values every 5 minutes for up to 72 hours. These reading are used with fingerstick results to detect trends and pattern in glucose level in adults next to diabetes, aged 18 years and over. The DexCom STS is indicated for use as an adjunctive device to complement, not replace, information obtained from standard home glucose monitoring devices.
Guidelines from the National Institute for Health and Clinical Excellence (2004) recommend the use of continuous glucose monitoring devices for the evaluation of those with type 1 diabetes on insulin dream therapy who have "repeated hypo- and hyperglycaemia at one and the same time each daylight, and hypoglycaemia unawareness, unresponsive to conventional insulin dose adjustment."
There is insufficient evidence to support the prolonged use of continuous glucose monitoring devices as an adjunct to home blood glucose monitoring. The potential advantages of adjunctive use of continuous glucose monitoring devices surrounded by managing persons next to poorly controlled diabetes are theoretical. There are no passable prospective clinical studies in the peer-reviewed published medical literature demonstrating that the use of continuous glucose monitoring devices results surrounded by durable improvements in outcomes of individuals near diabetes.
The American Diabetes Association Position Statement “Tests of Glycemia in Diabetes” (2004) recommend that the frequency and timing of glucose monitoring be dictated by the needs and goal of the individual patient. For most people with type 1 diabetes, self-monitoring of blood glucose three or four times day by day by the standard finger-stick method is sufficient. The ADA guidelines conclude that the “role [of CGMS] within improving diabetes outcomes remains to be established.”
A structured review of the evidence conducted by the BlueCross BlueShield Association Technology Evaluation Center (2003) concluded that “use of intermittent or continuous interstitial fluid glucose monitoring contained by patients with diabetes mellitus does not run into Blue Cross and Blue Shield Association Technology Evaluation Center criteria.” Similarly, a technology assessment conducted by the California Technology Assessment Forum (CTAF) concluded that CGMS does not meet CTAF's criteria (Tice, 2003). A draft technology assessment of self-monitoring of blood glucose within persons beside type 2 diabetes prepared for the Centers for Medicare and Medicaid Services (Balk, et al., 2006) commented that “currently, CGM [continuous glucose monitoring] has be studied primarily in children near type 1 diabetes. It is unclear whether CGM provides added worth to traditional SMBG [self monitoring of blood glucose].”
A major decrease of CGMS is the durability and stability of the glucose sensors. Interstitial glucose concentrations, obtained next to subcutaneous sensors, correlate with blood glucose concentrations. However, the sensors become progressively smaller quantity accurate over time, so they cannot be used on a maintenance justification, and must be changed every three days. Another potential concern is the six to ten minute delay contained by interstitial glucose sensor response to changes surrounded by serum glucose levels. This glitch appears to be most important when glucose level are falling rapidly, since it might result surrounded by development of clinically significant hypoglycemia in the past it was reflect in the sensor reading.
# TheraSense, Inc. FreeStyle Tracker Diabetes Management System. Special 510(k) device modification. 510(k) no. K020866. Rockville, MD: U.S. Food and Drug Administration, Center for Devices and Radiologic Health; June 11, 2002. Available at: http://www.fda.gov/cdrh/pdf2/k020866.pdf... Accessed February 24, 2002.
# Chico A, Vidal-Rios P, Subira M, et al. The continuous glucose monitoring system is adjectives for detecting unrecognized hypoglycemias in patients next to type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control. Diabetes Care. 2003;26(4):1153-1157.
# Amin R, Ross K, Acerini CL, et al. Hypoglycemia prevalence contained by prepubertal children with type 1 diabetes on standard insulin regimen: Use of continuous glucose monitoring system. Diabetes Care. 2003;26(3):662-667.
# Guerci B, Floriot M, Bohme P, et al. Clinical recitation of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs. Diabetes Care. 2003;26(3):582-589.
# Mastrototaro JJ, Gross TM. Reproducibility of the continuous glucose monitoring system match previous reports and the intended use of the product. Diabetes Care. 2003;26(1):256.
# Cheyne EH, Cavan DA, Kerr D. Performance of a continuous glucose monitoring system during controlled hypoglycaemia in tough volunteers. Diabetes Technol Ther. 2002;4(5):607-613.
# Kaufman FR, Austin J, Neinstein A, et al. Nocturnal hypoglycemia detected with the Continuous Glucose Monitoring System within pediatric patients with type 1 diabetes. J Pediatr. 2002;141(5):625-630.
# Choleau C, Dokladal P, Klein JC, et al. Prevention of hypoglycemia using risk assessment next to a continuous glucose monitoring system. Diabetes. 2002;51(11):3263-3273.
# Salardi S, Zucchini S, Santoni R, et al. The glucose area beneath the profiles obtained near continuous glucose monitoring system relationships with HbA(lc) within pediatric type 1 diabetic patients. Diabetes Care. 2002;25(10):1840-1844.
# Sharp P, Rainbow S. Continuous glucose monitoring and haemoglobin A(1c). Ann Clin Biochem. 2002;39(Pt 5):516-517.
# Speiser PW. Continuous glucose monitoring in managing diabetes contained by children. Diabetes Metab Res Rev. 2002;18(4):330-331.
# Schiaffini R, Ciampalini P, Fierabracci A, et al. The Continuous Glucose Monitoring System (CGMS) in type 1 diabetic children is the agency to reduce hypoglycemic risk. Diabetes Metab Res Rev. 2002;18(4):324-329.
# McGowan K, Thomas W, Moran A. Spurious reporting of nocturnal hypoglycemia by CGMS within patients with tightly controlled type 1 diabetes. Diabetes Care. 2002;25(9):1499-1503.
# Heinemann L, Koschinsky T. Continuous glucose monitoring: An overview of today's technology and their clinical applications. Int J Clin Pract Suppl. 2002;(129):75-79.
# Jamali R, Ludvigsson J, Mohseni S. Continuous monitoring of the subcutaneous glucose level within freely moving normal and diabetic rats and within humans with type 1 diabetes. Diabetes Technol Ther. 2002;4(3):305-312.
# Maran A, Crepaldi C, Tiengo A, et al. Continuous subcutaneous glucose monitoring within diabetic patients: A multicenter analysis. Diabetes Care. 2002;25(2):347-352.
# Kaufman FR, Gibson LC, Halvorson M, et al. A pilot study of the continuous glucose monitoring system: Clinical decisions and glycemic control after its use contained by pediatric type 1 diabetic subjects. Diabetes Care. 2001;24(12):2030-2034.
# Boland E, Monsod T, Delucia M, et al. Limitations of conventional methods of self-monitoring of blood glucose: Lessons learned from 3 days of continuous glucose sensing contained by pediatric patients with type 1 diabetes. Diabetes Care. 2001;24(11):1858-1862.
# Chase HP, Roberts MD, Wightman C, et al. Use of the GlucoWatch biographer surrounded by children with type 1 diabetes. Pediatrics. 2003;111(4 Pt 1):790-794.
# Robert JJ. Continuous monitoring of blood glucose. Horm Res. 2002;57 Suppl 1:81-84.
# Potts RO, Tamada JA, Tierney MJ. Glucose monitoring by reverse iontophoresis. Diabetes Metab Res Rev. 2002;18 Suppl 1:S49-S53.
# Tierney MJ, Tamada JA, Potts RO, et al. Clinical evaluation of the GlucoWatch biographer: A continual, non-invasive glucose monitor for patients next to diabetes. Biosens Bioelectron. 2001;16(9-12):621-629.
# Edelman SV. Watching your glucose with the GlucoWatch. Diabetes Technol Ther. 2001;3(2):283-284.
# No authors scheduled. Glucowatch Biographer: A noninvasive glucose monitoring device. Med Lett Drugs Ther. 2001;43(1104):42.
# Pitzer KR, Desai S, Dunn T, et al. Detection of hypoglycemia with the GlucoWatch biographer. Diabetes Care. 2001;24(5):881-885.
# Tierney MJ, Tamada JA, Potts RO, et al. The GlucoWatch biographer: A f
Please oblige near this enthusiasm insurance cross-examine:?
It fully depends on WHY they are denying the appeal.
They don't enjoy to give you any of that information.
You necessitate to take the common sense why they're denying it, and file a written complaint near your state insurance commissioner, refuting EVERY SINGLE POINT of denial.
If your insurance is self-insurance through your (or a spouses) employer group, ask HR for minister to. If not, ask the department of insurance in your state.
Its experimental. Sorry.
Preexisting condition - deviated septum - will insurance companies exclude or cover?
Common situation you met approaching many other relatives,therefor,be patient,and check the resource here i found adjectives.http://health-insurance.onlinebestoffer.
Resolved Questions: