CGMS Insurance question

[nab486]

Hi all,

Is everyone who has the Minimed CGMS system paying for it out of pocket? I would LOVE to have one but I don't know how much it ends up costing each month... do you use the sets longer than then 3 day reccomendation? My doctor suggested that people are leaving them in longer to save money and my minimed rep ...implied... couldn't really say... that they work great the longer they are in. How long can you stretch one?

Also.... if attempting to get insurance to cover at least some of it, what are they looking for? I have pretty good control.... is that a bad thing? A friend of mine is battling hers right now with major ups and downs (stress from a death in the family) would she have a better shot at getting it covered before she levels back off?

Jamie

[NoelD]

How long can you stretch one?= For safety, I go with one sensor a week, meaning I put on in Sunday evening, and replace it the following Sunday.

Also.... if attempting to get insurance to cover at least some of it, what are they looking for? I have pretty good control.... is that a bad thing? = Kinda, yes. I got mine for DP, and unexpected lows from time to time.

A friend of mine is battling hers right now with major ups and downs (stress from a death in the family) would she have a better shot at getting it covered before she levels back off?= Yes, that helps the cause.

[rmccully2000]

Check out this Yahoo group for CGM users diabetescgms : Diabetes CGMS (http://health.groups.yahoo.com/group/diabetescgms/) for more tips on getting insurance coverage. We were able to get UHC to cover the Dexcom without any trouble or requirements!

Once you join this free group, the File section on the left has some links and information about how others have won appeals and filed claims.

Good luck!
Becky, Mom to Mason, 7 Dexcom I-Port

[kgm0612]

I have United Health and they are NOT paying for it as of yet. Plus, I am on the 515 and to upgrade to the 522 would cost me $500. I'm going to hold off until United starts paying for it...........whenever that is!

To purchase it on your own it will cost you $999 for the starter kit which includes the following:

MiniLink™ REAL-Time Transmitter
10-pack of glucose sensors
SenSerter® insertion device
Transmitter adhesive patches (10)
IV3000 adhesive dressing (10)


A box of sensors (10) sells for $350.

Karen

[NoelD]

That $350 for 10 sensors can be negotiated down to what insurance companies on average pay, with is typically 50% or so.

[Robert in Tampa]

I have Federal Blue Cross & Blue Shield of Florida, my MM person called me today and said he had sumitted the claim for the CGMS. He said they have 15 days to respond to the claim to approve or request more information. I guess I will see. Is what I did was call the insurance company and ask to have a "case manager" assigned to me, after that, I was able to talk with him directly and explain the pending claim for the CGMS. He askes me several questions about the system (he had never heard of it) and I think I convinced him to process it. :cool:

[right2fight]

Good Luck to you, Robert in Tampa.

Margaret

[Dewey]

Hi Jamie,

On your first question about paying out of pocket, it does depend on the insurance & in some cases, the level of coverage. I've heard from some users, that if they have met their deductible, insurance may cover it (it's cheaper for them than buying the pump/cgms combo).

I don't think that having good control will prevent getting insurance coverage for the system, but since each plan is different, this may vary.

I've also heard that people are able to stretch their wear of the sensors for longer than the recommended 3-day use, but again, this may depend on an individual's reaction to the sensor (i.e. people who are more sensitive may not be able to wear them longer, etc.).

Hope things work out in terms of coverage and all. Good luck to you on this, and please keep us posted. :)

[nab486]

Ok so if I want to get the ball rolling on this, I call BCBS and ask for a case manager, get them to look into it and contact MM.... couldn't hurt to try right? maybe I can start a trend in SC!

[someone]

Ok so if I want to get the ball rolling on this, I call BCBS and ask for a case manager, get them to look into it and contact MM.... couldn't hurt to try right? maybe I can start a trend in SC!

Let me know how it goes with BCBS. I ordered my MM CGMS already, but maybe I can get some coverage on the sensors.

[JediSkipdogg]

Let me know how it goes with BCBS. I ordered my MM CGMS already, but maybe I can get some coverage on the sensors.

The problem is even the same insurance company is different in different areas. I heard when I got started on this ball that BCBS of Minnesota (I think) is the only insurance company in the country that will start someone on a CGMS with no questions asked. And in my pumpers meeting someone that had BCBS of Ohio has been having nothing but **** getting them to approve of it. Maybe the Minnesota branch is run by a diabetic, lol.

[condensr]

The problem is even the same insurance company is different in different areas. I heard when I got started on this ball that BCBS of Minnesota (I think) is the only insurance company in the country that will start someone on a CGMS with no questions asked.

Not true. My insurance will cover it 100% no questions, but I just havent been able to pick one. Not sure if I want to wait for the navigator. Apparently someone from Abbott was supposed to train a couple people at the clinic I go to on the Navigator this last week. (They're doing some sort of 1 year clinical trial that will use the Navigator.) They did something similar with the Dexcom, and they don't think its all that bad.

[JediSkipdogg]

Not true. My insurance will cover it 100% no questions, but I just havent been able to pick one.

That's just what the MM rep told me. :confused:

[condensr]

I'm sorry, that came across harsh. I didn't mean that like 'you're WRONG!' but more of a way to offer hope to some others that insurance coverage may indeed be available.

[nab486]

Well, I called BCBS and am in the process of having minimed call them and talk to the pre-certification people. Everyone has been very helpful so far. I will keep you guys posted!

[Injecto]

How long can you stretch one?= For safety, I go with one sensor a week, meaning I put on in Sunday evening, and replace it the following Sunday.


Not to threadjack entirely, but the above post brings up an interesting point that I forgot about in the infusion site change thread. Why is it considered O.K. to leave in a CGMS sensor for up to 6 days, but an infusion site is supposed to be changed every 3 days (or 4 for many people)? Wouldn't 6 days leave terrible scarring? Or is the 3 day thing not as serious as it has been advertised?

[panda1076]

I don't have first hand experience, but I would doubt leaving it in longer than 3 days is "scary". I heard that in Japan, people are told to wear their infusion sets for 2 weeks! (of course they do get skin irritation... but I doubt 6 days is so bad.)

But I am curious... Do any of you have trouble leaving the sensor in for so long without getting disconnect issues? I wore a minimed CGMS last week for 4 days as part of a study i am in, and after 2.5 days, I kept getting "disconn" error, and the customer service couldn't help me. I think he was at the point where if I was a regular customer he would have had me change my sensor. Is this a normal experience getting an error like this?

[JediSkipdogg]

Not to threadjack entirely, but the above post brings up an interesting point that I forgot about in the infusion site change thread. Why is it considered O.K. to leave in a CGMS sensor for up to 6 days, but an infusion site is supposed to be changed every 3 days (or 4 for many people)? Wouldn't 6 days leave terrible scarring? Or is the 3 day thing not as serious as it has been advertised?

The reason is because nothing is being put in. Your body doesn't mind items inside of it (hence why we can pierce 90% of our bodies.) The problem is what happens at the end of what is inserted that matters. If there is no other object being inserted, then it is fine. If something else, in the case of an infusion set, insulin, then you cause a problem. The body sees that insulin as a foreign substance and moves over to attack it with scar tissue to prevent it form coming in.

The current problem is the FDA doesn't believe that. They are stuck on the mindset of 3 days max no matter what. Yet in numerous studies (the longest one which Abbott has completed for their Navigator) shows no more signs of damage at 5 days vs. 3 days. The FDA just doesn't believe these studies which now Dexcom and Minimed have done their own of and are both in front of the FDA for.

There have been people that have worn a sensor for upwards of 20 days with no visible damage. Then again, I also know pumpers (from another site) that leave infusion sets in for 30 days at a time with no problems.

The major problem is the FDA has to put some time limit of these things. And with every body there is a different level of resistance and immunity. THerefore they have to decide on a safe level and that's hard for them to figure out. I'm just happy I'm not on the FDA panel.

[Injecto]

The reason is because nothing is being put in. Your body doesn't mind items inside of it (hence why we can pierce 90% of our bodies.) The problem is what happens at the end of what is inserted that matters. If there is no other object being inserted, then it is fine. If something else, in the case of an infusion set, insulin, then you cause a problem. The body sees that insulin as a foreign substance and moves over to attack it with scar tissue to prevent it form coming in.

The current problem is the FDA doesn't believe that. They are stuck on the mindset of 3 days max no matter what. Yet in numerous studies (the longest one which Abbott has completed for their Navigator) shows no more signs of damage at 5 days vs. 3 days. The FDA just doesn't believe these studies which now Dexcom and Minimed have done their own of and are both in front of the FDA for.

There have been people that have worn a sensor for upwards of 20 days with no visible damage. Then again, I also know pumpers (from another site) that leave infusion sets in for 30 days at a time with no problems.

The major problem is the FDA has to put some time limit of these things. And with every body there is a different level of resistance and immunity. THerefore they have to decide on a safe level and that's hard for them to figure out. I'm just happy I'm not on the FDA panel.


Cool. So then scarring shouldn't be a real problem with infusion sites (depending on person/individual experience of course). And it's even less of a problem with sensors (which don't shoot anything in you). Awesome read Jedi. Thanks.

[JediSkipdogg]

Cool. So then scarring shouldn't be a real problem with infusion sites (depending on person/individual experience of course). And it's even less of a problem with sensors (which don't shoot anything in you). Awesome read Jedi. Thanks.

The one thing I'd love to see if if the amount of insulin one infuses per day affects scarring or not. I've yet to find a study based on that. It only makes sense that the more you give the more likely you are to scar since the insulin causes the scarring.