Question about insurance for minilink and sensors

[Kayt]

Hello all,

I would like to get the minilink and the sensors that work with the paradigm 522. I'd like to find out, first, though if my insurance will even cover it. I'm prepared to fight for it, but I'm having trouble starting.

I called my insurance, Capital BlueCross BlueShield of PA. They are so confused. I don't think they've heard of it. They passed me off to the pharmacy, ExpressScripts, who has never heard it either.

What should I be saying, and to whom should I be speaking? Can someone give me some tips?

I really want this technology, but not enough to pay full price for it. If I could even get the insurance to pay a significant amount of it, I'd be happy.

Thanks,

Kayt

[NoelD]

Get your Minimed rep to get the ball rolling. They know just who to talk to.

[Kayt]

Thank you for the suggestion. I decided to give Minimed a try. Just got off the phone with someone very helpful who said they could start the process for me by checking with the insurance for me.

She did say it may take as long as 6 months because they don't have a billing code, but that most companies have been quicker about sending a reply.

So, I hope the answer is yes and I hope it's soon.

Kayt

[sticker]

My insurance wouldn't do a predetermination of benefits. They said, in my state, if a service or item is predetermined to be a covered benefit, they were 'locked-in' to cover that item or service and it was a 'business decision' not to do predeterminations in my state. What's up with that???

The CGMS is a device that has the potential to greatly improve the quality of life for the wearer in so many ways. I found it to be much easier to just buy the blasted thing and submit the claim. I didn't want them to have the opportunity to say, "You don't really need it. If you really did, you would already have it."

I wanted them to tell me i was denied for something I already had. I figured I'd be more inclined to fight to keep it than to get one. I wanted them to deny a life-giving device that I already had in place. Also, MiniMed is so busy filling orders for self-pay patients, I didn't want to unnecessarily delay the CGMS waiting for all the red-tape, because like you, I was told 6+ months, too.

I'm not saying you should take the same path I did. The risk is you might actually wind up being self-pay for something that admittedly, you will become VERY attached to, very quickly. I think it would be very, very hard to unplug
this thing, once you've used it a while.

I don't expect it will be too long before the insurance cos. realize the benefits outweigh the costs, so should you decide to go self-pay, I predict it won't be long before it will become widely accepted as a covered item. For me, it was sooner than later, as I just received reimbursement, yesterday.

[NoelD]

you will become VERY attached to, very quickly. I think it would be very, very hard to unplug
this thing, once you've used it a while.

VERY true. I feel LOST when in the 2 hour calibration period. It would bring a tear to my eye to have to give this thing up.

[Kayt]

Hi all,

Just an update...got a call yesterday from Minimed that they had faxed a pre-authorization form to my insurance.

Thanks for all your comments.

Kayt

[grove.armada]

Kayt, Can you give me more details on form your rep sent to the insurance company. My local rep is clueless and not that helpful.

[Kayt]

Just wanted to let you know, I got a call from Minimed and they said my insurance denied the request for CGMS.

I'm gonna call insurance now and find out what I need to do to appeal their decision.

When I called Minimed to start this, they said they needed to put in an order and then they would send paperwork to my insurance.

I just let Minimed do all the work. Now I gotta pick it up, but at least now the insurance will have a clue what I'm talking about.

Kayt