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I received a call today informing me that my HMO (Harvard Pilgrim Health Care) has decided to discontinue coverage of the CGMS. I am so sad. My A1c at the start of my CGMS use was 7.4%. Within 90 days of CGMS use, I dropped to a 6.7%. I am so sad that they will not cover it anymore as I cannot afford to be on it without their assistance. At $30 per sensor I will be paying just under $90 per week to continue using this. I cannot keep the sensor on the 6-7 days that some users are able to due to sensitive skin irritation that I encounter if I push use beyond the 3-day mark. I will have to give this wonderful device up once they discontinue coverage...date TBA. If you have Harvard Pilgrim, please help me to fight this! Call and voice your opinion 1-888-333-4742. They need to understand that they will ultimately pay more money covering our medical bills due to diabetes-related complications (that this wonderful device can surely help to prevent) than they will for paying for this device upfront. I feel defeated; I was so very happy with my health plan and everything Harvard Pilgrim was doing to help me improve my health. Now, I feel that they have given up the fight.

Views: 16

Tags: CGM, CGMS, Coverage, HMO, Harvard, HarvardPilgrim, Insurance, InsuranceCoverage, Pilgrim

Comment by itsnotabeeper on March 27, 2008 at 8:44pm
No, actually I loved using them for 6 days. I found my readings were better after the 3 day point passed. However, I have high skin sensitivity to the sensors and basically any adhesive that touches my skin, so I have begun changing my sensors every 3 days to avoid infection/irritation.
Comment by Jenny on March 28, 2008 at 8:41am
Can you appeal through whatever process they have for appeals.

I have Fallon and the nurse there told me they have all kinds of rules and regulations, but if you get your doctor to write a letter, they will ease up on many of the things that sound iron clad.

So find out what their appeals process is and see if you can appeal.
Comment by itsnotabeeper on May 30, 2008 at 7:36am
Great news! I have heard that a doctor in Atlanta, GA (David Body) has done some research on the effectiveness of the CGMS pump that has helped convince Harvard Pilgrim Healthcare to cover this system again! I have not tracked down any proof of this online yet, but the news is so promising!!!


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