Continuous Glucose Monitoring (CGMS) Insurance Coverage
I am currently going through the process of obtaining insurance coverage for my Minimed Real Time Blood Glucose Monitor and sensors.
I am asking for people to to reply to this post with any suggestions. I am looking for people to share how they got the insurance companies to pay for the sensors as well as those that have been denied insurance coverage.
Feel free to include the name of the insurance company. I use Humana and will keep everyone posted. I'm currently awaiting for my doctor to send a letter of medical necessity to my insurance company.
Thanks!
posted by Dia-Log.com @ 9:18 AM
11 Comments
11 Comments:
My insurance covered the cost, but supposedly for only one month. I've only had it a week, so I'm not sure what will happen when I need to order more sensors. I called MM and they did all the leg work for me. I may have to contact my insurance if they don't cover "refills" though. So call MM and see if they'll do the calling for you:)
Hi. I happen to have been very lucky in getting coverage for both the paradigm 522 meter and sensor starter kit including transmitter.
My insurance company has been quite annoying on many subjects and has not given me great coverage overall.
However, Blue Cross/Blue Shield of Minnesota happens to be the company that Medtronic/MiniMed uses for their own insurance.
If you are able to choose them for your insurance, that will help a lot. You will still need to get the doctor to write a statement of need.
You will also need to show 30 days of readings, at least 8 per day, preferably from a month with significant highs and lows.
If you can show that you have actually required medical attention for lows, that will help too. I have not had that particular misfortune.
Anyway, I hope this information helps you get the CGMS system but would caution you about your expectations for it. I have had mine for 2 weeks now, so am definitely no expert.
The learning curve is tremendous. The lag between blood glucose and interstitial glucose can be 40 minutes. Exercise may, though I will need to use this a lot longer to verify, cause interstitial glucose to drop before blood glucose.
Offices with a lot of radio interference, wifi, cell phones, blue tooth, cordless ear pieces, microwave ovens, etc., etc., etc., can cause the transmitter to fail to transmit even over distances shorter than my index finger, even when my cell phone is physically off or just on my other hip.
It is a tool. It can be helpful. I have already adjusted my night time basal due to its readings. But, keep your expectations realistic.
Best of luck with this. I've heard that if you enclose some of the technical papers demonstrating efficacy that may help. You can find these on the Dexcom site.
I'm dragging my heels on this one. I've got Aetna and the paperwork is too tiring even to think about. Maybe after my bike ride is behind me.
My Medicare special needs PPO sayds they will cover at 100 %. The problem is that my 712 pump is 2 years old and Minimed is dragging their feet in helping me obtain the new pump and monitoring platform. You would think they would be jumping at the chance to have a complete set paid for by the insurer. If any Minimed rep reads thsi please tal to your phone reps. The just do not seem to get it.
I recently upgraded my pump to the Medtronic Paradigm 522 to be used with the continuous glocose monitoring system (CGMS). I have Federal Blue Cross Blue Shield. I called them a few times to discuss their coverage policy and protocol. Additionally, Medtronic told me they wouldn't bill the insurance company--the patient has to bill the insurance company. I ordered the CGMS and obtained a letter of medical necessity from my doctor and pieces of my medical record demonstrating my "unexplained blood glucose fluctuations" (these exact words were important to have in the letter, because unexplained fluctuations are one reason BCBS covers CGMS). I went through the tiring process of submitting multiple letters and information and I just found out that BCBS is going to reimburse me for half of the cost. This sounds great and exciting until I found out if I had just ordered the CGMS from Libery Medical Supply (where I get all my other pump supplies) and given them the letter of medical necessity it would have been covered at 90% and I would have only been out of pocket 10% (rather than 50%). I also could have saved myself alot of hassle of not messing with BCBS.
I hope other people reading this will learn from my mistake. My suggestion for folks trying to get their CGMS reimbursed is--do NOT order the system through Medtronic, order it through one of your insurance company's preferred "medical equipment suppliers". That company then does all the work and you pay a small copay. I asked BCBS why they didn't mention this to me during one of the five phonecalls I made to them before I ordered the system from Medtronic and they just said that it's not standard protocol to suggest patients order through preferred providers.
Best of luck to all those going down this road!
I used the sensors for several months and they definitely helped to lower my A1c, because you don't worry about going low. They were covered by Health Partners. I switched jobs 5 months ago, and now am stuck with Blue Cross. It took 2 months to figure out that I need to apply to have it approved as a durable good. I have been waiting on that approval for 3 months. Blue Cross is a joke.
I've been on the pump for almost 5 years. Blue Cross covered 80% of the cost of the pump and supplies. It got really expensive.
I'm now with Tufts and they cover 100% of a new pump, supplies and also, after a battle, CGMS coverage. I'm in Massachusetts.
I have presbyterian(New Mexico) When I decided I wanted to pump instead of MDI My insurance covered 100 percent of any diabetic supplies, pump, meter, test strips, sensors, transmitor, infusion sets, alchohol wipes, tegaderm(for the sensors) and lancets.
All i ever had to send was a letter of medical neccessity from my ENDO and attest that I am hypo unaware for the sensors.
It best to compare all insurances plans from several insurances company and than choose the best plan for you.
We are so disappointed!!! My husband had a one week trail using a sensor..and was delighted with the results..less testing..and it kept his blood sugar levels in a good range..not getting those lows, were a giant relief.. He already has the pump which our insurance has covered.. however he was denied coverage for the sensor..He has Medicare plus a UPMC supplemental insurance..reason given for the dential was that the sensor was EXPERIMENTAL !!! Really??? Our young neighbor was approved for a sensor...by her insurance company.. I don't get it...If it is not experimental for my 27 year old neighbor..why is it experimental for my 70 year old husband??? Is there any way we can appeal this...any where we can turn to for help on this matter.. I have to say...I can't help to think, that we of the baby boomer generation...are getting a raw deal because there are so many of us..makes me wonder if the government and insurance industry is trying to weed out our numbers...
Please respond, with any suggestions or advice, it would be greatly appreciated..Many thanks !!
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