A Letter to the CEO of Humana

4/21/16
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Editor’s Note & Update 04/23/16: Esme’s family received a response from Humana today, approving Esme for both a CGM and an insulin pump. We want to thank Humana for giving Esme the devices that she needs to combat Type 1 diabetes, and to thank our community for joining us in this fight. Esme represents one of thousands fighting for the medical coverage that they need and deserve. She also represents the change that is created when the DOC stands together. Humana’s decision is a starting point, but we have to remember that there are countless others who are still fighting for the coverage that they need. We hope you’ll continue to join us in these fights. 
 
Editor’s Note 04/22/16: At Beyond Type 1, we recognize that thousands of people with Type 1 diabetes in many parts of the world are denied coverage for the care that they need — and this must change. Below is a copy of the letter that Beyond Type 1 Co-Founder & CEO Sarah Lucas sent to Humana’s CEO Bruce Broussard regarding the specific case now pending for Esme Hennessy. We encourage you to reach out to Mr. Broussard via email bbroussard@humana.com or Twitter @BruceDBroussard, asking that Esme’s appeal be approved and that Humana revamp their policies for Type 1 clients. We encourage you to use the letter below for inspiration or write your own. While the tragic reality is that Esme’s story is one of many, we must begin somewhere, and so we ask for your help. The tools needed to manage this disease are necessities, not luxuries.

April 21, 2016

Attn: Mr. Bruce Broussard, President & CEO

Humana

500 W. Main St

Louisville, KY 40202

Dear Mr. Broussard:

It has been brought to my attention that coverage has been denied, repeatedly, to parents Theodore Hennessy and Fay Kolly for their daughter Esme to receive a CGM and insulin pump. My co-founders, Juliet de Baubigny, Nick Jonas, Sam Talbot and I hope that Humana will re-review their request and opt to provide their 2-year-old daughter with the tools necessary to safeguard her health.

After her diagnosis with Type 1 diabetes in February of this year, Esme’s pediatric endocrinologist, Dr. Joshua Smith, prescribed an insulin pump and CGM system after considering all alternatives. The prescribed devices are clinically appropriate for treating her illness and are being used to prevent bodily injury from occurring as a result of her illness. Esme’s doctor has confirmed that the alternative services (MDI and SMBG) are not able to produce equivalent therapeutic or diagnostic results due to her age and size. Furthermore, this patient’s requests align with medically accepted, peer-reviewed research studies proving the efficacy and therapeutic benefits of these devices. The patient’s own medical logs show she is experiencing hypoglycemic unawareness, severe hypoglycemia, severe glycemic excursions, wide fluctuations in blood glucose before mealtime, a HbA1C greater than 7.0, and a history of inadequate glycemic control. Without proper care, Esme could suffer from a wide variety of symptoms such as seizures, coma, brain damage, retinopathy and death. 

Despite the substantial information provided, the claim was denied a third time this week — after what Humana has called a peer-to-peer review, completed with an oncologist as the medical expert. Esme’s request now awaits a fourth review, this time by an outside review board, with initial indication that the decision would be issued Friday, April 22nd at noon. On Wednesday, April 20th, Esme’s parents received an email from Humana representative Joe Kirsch, indicating that this may be further delayed as a pediatric endocrinologist had yet to be found to participate in the process. First, a pediatric endocrinologist did participate in the process — he is the one who prescribed the devices initially. Second, if Humana or the independent review board are struggling to source a pediatric endocrinologist for an appropriate peer-review, we will gladly provide them with a list. 

This process is cruel. A child now lives with a chronic, life-threatening disease and her family is tasked with keeping her safe. A doctor has prescribed medical care; Humana has denied that medical care three times and has now outsourced the decision to a private entity that seems incapable of finding a qualified expert to review the case. Esme and her family continue to wait. Type 1 diabetes does not wait and we will not wait, because Esme and the millions like her cannot wait. This family deserves the technology that a doctor has indicated is critical care. These devices are necessities, not luxuries. Humana needs to honor their mission, approve this request, and revamp their policies for all those living with Type 1 diabetes. Parents and individuals must be supported by their insurance providers as they navigate this chronic disease and the time, energy and money spent fighting for the prescribed basics could be turned to other endeavors, like living. 

 sarah_signature_2

Sarah Lucas

Co-Founder & CEO, Beyond Type 1

www.beyondtype1.org