If you have questions about the practices of your managed-care coverage, ask the experts at the state Department of Managed Health Care. They take up issues ranging from difficulties getting an appointment to denial of a doctor's recommendation for treatment.
I have Type 1 diabetes with hypoglycemic unawareness, a fancy way of saying that I am unable to tell when my blood sugar level is getting low because I no longer get symptoms.
I have been using a Medtronic glucose sensor device that warns me of oncoming hypoglycemia before it actually happens.
This machine helps me avoid potentially life-threatening hypoglycemic reactions. Even though my endocrinologist petitioned my health plan to cover the monthly $350 cost of this machine, my health plan denied my request and recommended that I consult with my primary-care physician for a different treatment.
– Nancy Bukowski, Carmichael
Our review of your case revealed that your health plan's denial was based on a conclusion that continuous glucose monitoring is an experimental or investigational treatment – and therefore not medically necessary.
The DMHC asked an independent panel of three physicians to review your case to determine whether your request for payment of the continuous glucose monitor would be likely to be more beneficial than any other standard therapies.
The majority of the reviewers agreed with you and your doctor, in part because of your hypoglycemic unawareness. As a result, your health plan's denial was overturned, and it will now pay for use of the glucose monitor as long as you are enrolled.
For more information about diabetes, consumers can log onto the American Diabetes Association Web site at www.diabetes.org. By the way, November is American Diabetes Month.
Also, the Department of Managed Health Care has launched a three-year effort called the Right Care Initiative. We are working with California's health plans on improving care in three key areas – heart disease, diabetes and hospital-acquired infections – to accelerate effective and inexpensive treatments for our biggest killers – heart disease and diabetes.
Diabetes has increased significantly in the past 10 years, with more than 1.5 million new cases diagnosed nationally last year alone.
Not only is diabetes a serious chronic illness, it can lead to other complications such as heart disease, stroke, kidney disease, blindness and amputations.
To ask a question, go to www.sacbee.com/ask or write Second Opinion; Features Department; The Sacramento Bee, P.O. Box 15779, Sacramento, CA 95852.
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