BCBS IL Medical Directors

[Laurie]

The Medical Directors responsible for our Medical Policy Guidelines (MPG)
for the four Blue Cross and Blue Shield plans (Texas, Illinois, Oklahoma,
and New Mexico) include: Dr. Allan Chernov, Dr. W. Harms, Dr. P. Root and Dr.
M. Fontana.

One piece of information! We know these people are responsible for why these plans aren't covering CGMS.

Chernov is an internal medicine doctor...He is the director of medical policy for BCBS TX.

I don't have any specific suggestions, but I've heard the idea of reporting doctors to state medical boards stating that they need to be investigated for practicing incompetently and needing education to make proper decisions.

Another point is that the Standards of Medical Care in Diabetes indicate, "Continuous Glucose Monitoring may be a supplemental tool to SMBG for selected patients with type I diabetes, especially those with hypoglycemic unawareness."

This is listed here:

http://www.bcbstx.com/provider/lifemasters_cpg.htm

If this is used by BCBS, why are they refusing to cover CGMS per the standards they themselves cite?

[BlondeSwtP]

Useful data, thank you! And I have wondered about the same thing regarding standards. Other BCBS have approved the CGMS, but Illinois keeps denying which makes no sense. All I (we) can do is keep trying. If we don't fight, we won't move forward :)

[Laurie]

I really think it is because of the medical directors with this team. I don't know why (there are a million reasons) but it is unfortunate to say the least that they won't approve it. Must keep fighting...cannot stop!

[Laurie]

More contact info! BCBS IL Directors!

Medical Directors
Kim Reed, M.D., Senior Medical Director 1-312-653-5487

Richard Gayes, M.D., Medical Director,
Medical Network Management
1-312-653-5065

Carol Wilhoit, M. D., Medical Director, Quality
Management
1-312-653-2446

[Tarra Robinson]

I have been denied three time now. Looks like i know why now. I live in the state of Texas and i am a state employee. The only thing they will cover is three day Cgms device. It is such a joke what about the rest of the month. I plan to keep fighting but this is really getting old.

[Mary Ann]

Thanks for the phone numbers for BCBS of Illinois directors, I will call this week and see where I get!

Mary

[Dan Sprehe]

Laurie,

Thank you for posting these, even though the discussion started and ended months ago. I live in Illinois and will continue fighting, tooth and nail, until this is resolved. My A1C is terrific. Even so, after nearly 20 years with Type 1 DM, I suffered two of the most frightening hypoglycemic experiences of my entire life just last month. I was fortunate to have regained enough consciousness and motor skills to get some carbs into me.

More importantly, thank you for providing the name of the BCBS-IL medical directors, to whom I can write directly. While I am upset and angry that these devices are not covered, I look forward to engaging them, as best I can, in constructive dialogue. Even though they've probably heard it 1,000 times already, they can look forward to hearing it 1,000 more.

Best,

Dan