Anyone had luck with insurance paying for continuous BGL monitor?

[KEVIN88GT]

like the minimed continuous monitor that sends readings to the pump every 5 minutes?

Right now minimed sais $ 650 for the monitor and $35 bucks per sensor. (Thats like over 280 bucks per month for sensors!!)

[greengirl]

My insurance payed for the glucowatch and the sensors 2-3 years ago. I tried tried tried but it was horribly innacurate for me. My insurance approved it off the bat and I had no copay. I was told the would pay for minimed cgms and sensors but I would have a 20% copay. All my DME has a 20% copay starting this year. Right now I'm trying to decide if I want to go ahead and get the dexcom or wait and hope that the navigator comes out before I lose insurance under my parents at the end of this year. The will pay for new cgms every 2 years.

That said I have good insurance. There is no pre-approval for pumps, even. And I was eligible for extended insurance on my parents insurance simply because of 3 medical conditions I have are considered lifelong. I will be insured as long as they work, unfortunately they retire at the end of this year. I'm about to turn 26 and still covered! Sometimes it pays to have parents who work for an Oil company, they really are not too evil.

My plan is manganed by Aetna and is a POS II. I do know that the company my parents work for can make their own rules on some stuff, so a lot of the typical stuff may not apply. YMMV.

[NoelD]

BCBS of GA paid 90% of mine and for the sensors as well. Your MM rep will or should know how to proceed.

[kgm0612]

I have United Healthcare and they are NOT paying for it! I had an endo appointment yesterday and he suggested that I upgrade from the 515 to the 522 and try the sensors. He sent the nurse in to talk to me about it (she's a pumper) and when I told her I had United, she said "NOPE, they will not pay". She even put in a call to United while I sat there and again, was told they were not paying for it at this time.

Yet......According to my morning paper (Providence Journal).....United Healthcare of New England has $37 milliion dollars in extra profits!

Karen

[It Ain't Over]

I was told they were not paying for it at this time.

Yet......According to my morning paper (Providence Journal).....United Healthcare of New England has $37 milliion dollars in extra profits!

Karen

Godless Buffoons. Well I am going to a MM meeting tonight. Anybody have any experience with Blue Cross?

[NoelD]

It Ain't Over, Blue Cross of GA paid 90% on mine and the sensors. It takes a bit of work, but most arms of Blue Cross are paying in some way I think.

[rmccully2000]

I have posted our EOB from UHC showing the Dexcom sensors covered as out-of-network. You're more than welcome to use it. Contact me and I can give you more specific info.

Go here and look in the files section: It's called Dexcom_EOB3.jpg

diabetescgms : Diabetes CGMS (http://health.groups.yahoo.com/group/diabetescgms/)

It might help if you tell them you know someone who got coverage without an appeal or requirements. We also have misc codes if they bring this up. It's a bunk argument.



Good luck,
Becky, Mom to Mason, 7, Dexcom, Iport

I have United Healthcare and they are NOT paying for it! I had an endo appointment yesterday and he suggested that I upgrade from the 515 to the 522 and try the sensors. He sent the nurse in to talk to me about it (she's a pumper) and when I told her I had United, she said "NOPE, they will not pay". She even put in a call to United while I sat there and again, was told they were not paying for it at this time.

Yet......According to my morning paper (Providence Journal).....United Healthcare of New England has $37 milliion dollars in extra profits!

Karen

[egi]

How did you get BC to pay?

We have BC of CA and I could not get any info on how to even
begin the approval process with them - any pointers? charge
codes?

[Dewey]

Sorry to hear United's not helping you, Karen. :( Does it depend on the area or type of coverage? My hubby called & told our insurance specifically what we wanted, & the customer rep. told him they'd cover it. She also stated that since the deductible was met, they'd cover sensors 100%. Sensors fall under DME, so you may have an argument there (in your favor).

Maybe we misunderstood, but I'm hoping that they're going to cover it. If not, we may have to take an alternative route.

[kgm0612]

Hey Dewey.........My husband works for the State. We have, so we've been told, one of the best plans United has to offer. My husband doesn't contribute a penny towards our family plan (that will change as soon as a new contract is negotiated) nor do we have any out of pocket deductables to meet. We have a $10 co-pay for each doctor's visit, and our prescription co-pays are $5 & $12. So I can't complain about any of that..........I'm fortuante enough to have insurance!

I need to call United later today regarding the claims they keep denying every month for my test strips, so I'm going to ask about the kit & sensors while I have them on the phone. Apparently, they think the 300 test strips a month I order is "EXCESSIVE". I almost fell out of my chair when the United rep told me that last month when I called! Type 1 pumper.....testing 8, 10, sometimes 12 times a day and 300 test strips are excessive? A third-grader could do the math and come up with the numbers faster than they can! LOL

I'll let you know how I make out when I give them a call! Keep your fingers crossed that I get someone who knows what they're talking about and tells me they ARE covered!

Karen

[Dewey]

This is precisely why I hate insurance companies. :( One customer rep. will say one thing, and another will say something different. My feelings on that is that the company should honor the coverage, especially if a rep. tells a client they will be covered (whether the rep said it in err or not!).

I've had United before & have never had a problem with them in the past. It's only recently that I've seen a downward trend regarding their coverage of some things (i.e. covering less test strips & the like).

Even though I didn't really care much for Cigna, I truly couldn't complain. They got me a new pump when I decided to upgrade/switch (in the past), No questions asked....and heck, neither you or I are asking for new pumps (which would be far more expensive!).

I think insurance companies cause more issues on people than anything else in life! Nothing like having to fight for things we & our health could truly benefit from, or having to do THEIR job when we really need something! (Sorry, I'm just miffed). :banghead:

[kgm0612]

EXACTLY! When MM first contacted United regarding my insurance coverage (11/05), the rep at United said my pump and supplies were covered at 100%. March rolled around and I get a statement from MM with a balance owing of $1200. I immediately called MM and was told they would take care of it because it should have been paid in full. April, I get another statement and place another call. MM will take care of the situation. May, same thing. Finally I called United myself and the rep I spoke with said, "DME is covered at 80%, not 100%". Make a very long story short, MM ended up writing off the balance of $1200 because they were in error. Apparently, the rep at MM misunderstood the rep from United and I was caught in the middle.

Karen

[mcneely]

I hate to break this thread up, but are you sure you even want a continuous glucos monitoring system? I wore one (the kind only the doc keeps on hand) a few years back for three days and hated it. I know the new technology has made it more comfortable and promising with so much control, but, still - wearing two devices rather than one? And, I believe you have to change the monitor several times a week.

That might explain why minimed is lowering the price because they are not selling them as quickly as they planned. A supply and demand issue.

[JediSkipdogg]

I hate to break this thread up, but are you sure you even want a continuous glucos monitoring system? I wore one (the kind only the doc keeps on hand) a few years back for three days and hated it. I know the new technology has made it more comfortable and promising with so much control, but, still - wearing two devices rather than one? And, I believe you have to change the monitor several times a week.

You can wear the sensor for a week without any problems (the FDA says 3 days, but 7 has worked for many with no problems.) The one your probably wore also had a wire attached to it. I wore that version and hated it. The new version is just like an insulin pump without the tubing. So no wire attached and a very small transmitter.

That might explain why minimed is lowering the price because they are not selling them as quickly as they planned. A supply and demand issue.

It's not a supply and demand....it's a you have to pay out of pocket for it generally unless you are one that doesn't mind fighting the insurance company with appeals. Most don't want to do that and don't want to pay the fortune, so they just go without.

The reason I think MM is lowering the price on the Guardian RT is because you can buy the Dexcom for $800 or $500 if you get the special price (not sure how you get that.) So to show any competion they need to lower the price of the original reciever since the sensors cost the exact same price and last the same length of time.

[Dewey]

Ok, hubby called our insurance (twice now) to make sure that what he heard the first time was the truth. He asked them each time if they would cover the MiniMed Guardian Real-Time CGMS system, and Both times, they told him they would. All they said they need is a letter of medical necessity and the doctor can categorize the CGMS system prescription as pump-like equipment (i.e. DME). For this, they said they'd cover up to 90%.

[kgm0612]

Dewey...........Good luck to you!