[modbom]

I just got approved by Oxford. Here's what minimed suggested I do with regards to my insurance company:

The first step when trying to get coverage on the Paradigm Real Time Continuous Glucose monitor is to ask for a single case negotiation. Get a case number, pre determination number, or pre certification number (different insurance companies call it different things) from an insurance company. It’s best to speak with a case manager, not the customer service rep that answers initial call. The patient should know what they are asking for so they should read the attachments prior to making the initial call.

Some questions that may be asked:

1. Diagnosis code-250.03 (this code is considered uncontrolled type 1 diabetes) 250.01 is type 1 diabetes- Juvenile Diabetes. You may ask you health care provider what your diagnosis code is.


2. Description and cost of item

Paradigm Real Time Continuous Glucose Monitor $999
Monthly ongoing cost of sensors $350
Code- this is where it gets tricky. We use a miscellaneous code to bill for this since it's such a new product for us. The code we use is E1399.

3. Date of Service- depends on availability. It’s safe to say one month after the conversation with the insurance company takes place.

4. Manufacturer information
Medtronic Minimed
18000 Devonshire Street
Northridge, CA 91325
phone- 800.933.3322
tax id- 954662001

5. If the insurance company says you do not need a case number or pre determination because it is a covered item, talk with someone else.


It’s usually a good idea to speak with a case manager that has a medical background. You will want to make sure they do not think you are asking for coverage for an insulin pump or a glucometer. They need to know this is a new device that has only been available since May 2006.

VERY IMPORTANT- Once you speak with a case manager, let them know your doctor would like to send in supporting documentation. Please get the fax number used to send in supporting documentation, case manager name, phone number, and extension. At that point in time, I usually work with the patient to get relevant health information to put together a letter. I email the letter to the educator, social worker, or doctor and they fax either to the patient or to the insurance company directly. If it goes to the patient I ask them to include blood sugar logs, the guard control trial, and hcp product description.