09 July 2008
Premera Blue Cross
Attention: Member Appeal
RE: Sáin Ravenscroft
Member ID XXXXXXXXXXX
Group # XXXXXXX
Ref No XXXXXXXXX
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”
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