Prior Authorization


So, thanks to United Healthcare’s  policy toward continuous glucose monitors, I have been enjoying Abbott’s Freestyle Navigator for about a month now. The sensor is large, and there’s a part of the battery that keeps wearing into my skin, leaving red indentations reminiscent of cigarette burns — but these are but small prices to pay for the experience of being able to see my glucose levels at all times. I must check the thing upwards of 100 times a day — scrolling through my line graphs, adding events like insulin, meals and exercise, looking at my 3-, 7-, 14-, 21- and 28-day averages, carrying it with me while I go running, using it to tell when I need a Gatorade boost during spin class, examining my overnight trends . . . I love it. Yes, dear readers, I’m not ashamed to admit it: I am in love with my CGM.

But bad news has just struck our nascent romance: starting February 1st, my insurance switched from United Health Care to Blue Shield of California. And according to my supplier, Blue Shield does not want to cover my CGM. Or, rather, it refuses to cover it without those two words dreaded by anyone attempting to get insurance coverage: prior authorization.

What I love about this “prior authorization” thing is that the insurance companies are talking about themselves. *They* have to provide “prior authorization” I would think that by stating that they “cover” CGMs, they are giving prior approval — but no. They want to make sure this is worth their money. So I’m supposed to send them 2 months’ worth of glucose records. Why? To prove that I have a “medical necessity” for a CGM.

I want to be like, hey, assholes, I’m DIABETIC. *That’s* my medical necessity. But somehow I don’t think that’s going to go over well. So instead I have to wait a couple of weeks till Abbott releases software that lets you download your glucose numbers (the thing sends a signal every minute — I’m not transcribing that shit by hand). And then I have to look through about three other glucometers to try to put together the rest of my numbers. And for what? So some bureaucrat in Blue Shield can sort through them and decide that I don’t deserve a CGM? At this point, anyone who doesn’t think seeing your glucose levels in near-real time is an improvement over finger-sticks should require prior authorization — for being an idiot.

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