Wednesday, July 9, 2008

Most Painful Thing I've EVER Written

09 July 2008

Premera Blue Cross
Attention: Member Appeal

PO Box 91102
Seattle, WA 98111-9202

RE: Sáin Ravenscroft

To Whom It May Concern:

Please accept this letter as Sáin Ravenscroft’s appeal to Premera Blue Cross’ decision to deny coverage for the MiniMed Paradigm Real Time Continuous Glucose Monitoring System and related supplies. It is my understanding based on your letter of denial dated June 24, 2008 that this service was denied because:

it is considered experimental/investigational” and “additional research is necessary before this service can be classified as equally or more effective when compared to conventional diagnostic and/or therapeutic interventions” and “uses…beyond three days are considered investigational

Although the continuous glucose monitor is a relatively new technology, it’s effectiveness (beyond three days) has been proven in many studies and is FDA approved for children ages 7 and up. A three day usage of the continuous glucose monitor might be enough if blood sugars were only affected by food but they are not. Blood sugar levels are affected by growth, stress, weather, changes in altitude, and exercise, just to name a few. [see appendix A, B, C and D]

We are not asking to replace the conventional blood sugar testing (finger pokes.) The continuous glucose monitor would be used in conjunction with regular finger pokes to better control Sáin’s numbers and to prevent unpredictable highs and lows, especially at night.

Like many diabetics, Sáin unable to awaken from hypoglycemic episodes at night. [see appendix E] An undetected hypoglycemic episode can cause serious even fatal complications. A continuous glucose monitor would alert us if Sáin’s blood sugar dropped below 90 and we would be able to treat it before any complications occurred. Currently I am testing Sáin 2 – 3 times every night. Even with my 2 – 3 tests, Sáin has had a handful of serious lows (blood sugars in the 20s and 30s) while sleeping.

By approving a continuous glucose monitor for Sáin, you are allowing her the opportunity to better control her disease and thus reduce her chance of eye disease by 76%, chance of kidney disease by 50% and chance of nerve damage by 60%. You are also spending a small amount now (approximately $4200 annually) to save a large amount (approximately $26,000 for ONE hospital stay for a severe hypoglycemic episode) in the future. [see appendix F]

Please approve this service for Sáin.

Background on Sáin Ravenscroft:

As you know, Sáin was diagnosed with Type 1 Diabetes Mellitus on 05 April 2005 – she was only 5 years old. Despite her constant vigilance (a vigilance that puts many adults with the disease to shame), and the constant vigilance of her family, healthcare providers, and school personnel, Sáin has experienced severe highs and dangerous lows. No matter how tightly we control Sáin’s food to insulin ratios, it is impossible to predict all the dangerous highs and lows before serious, even fatal, complications occur with finger pricks alone.

As I stated earlier, I am not asking to replace finger pricks, truth be known I will still test Sáin 8 – 10 times a day even with the continuous glucose monitor. What I am asking for a proven device that would give us a chance to stop the highs and lows before they become life threatening.

Please consider our appeal. By denying Sáin the continuous glucose monitor requested by her Endocrinology team, you are denying an 8 year old girl the opportunity for the future she deserves and denying those who love her the peace of mind they deserve.

Thank you,

Angie Ravenscroft


Jonathan said...

Good luck!!! Know that Shelley and I are praying for you guys.

Anonymous said...

"A continuous glucose monitor would alert us if Sáin’s blood sugar dropped below 90 and we would be able to treat it before any complications occurred."

Why would you "treat" a <90? That's a perfectly normal reading! In fact, that's what you should be aiming for. Maybe this is why you think she doesn't wake up when hypoglicemic? Because you've got your numbers wrong?

A low is <70, and even then, I've had many 50's and one or two 30's and wouldn't consider anything above 50 to be too serious.

Good luck in getting approval for the Minimed. The amount of ignorance about diabetes out there, even in the medical field, is apalling. I once was administered insulin at a hospital "because I was low on blood sugar" (56). Talk about "WTF!?"

Angie said...

to anonymous

In pediatrics a low is ofter considered less than 90.. hence the reasoning for minimeds pediatric CGM having a setting of 90 for a low blood sugar alarm. I realise there are variations between different endos but 90 is a good standard in kids and is a good point to start checking more rigorously.

My daughter's prescribed range is 80-140.

I don't correct my daughter until she is below 80 per her endo's request but do test often when she's in that low range to see which way her numbers are going.

More power to you if you are comfortable with your blood sugars in the 50's; I am not comfortable with the idea of multiple lows (even in the 50's)in my daughter. I've seen her seize in the upper 40s and be fine at 24. No two hypos are the same and I'm not willing to take those kind of chances with her life.