Sensors and Insurance

[solox316]

Hi all,

I know people have talked about this bits and pieces in other threads, but I hoping to hear from people directly.

What has been your experiences with insurance and cgms sensors? I will be getting a new pump in October and am really hoping to get the Medtronic with the Guardian.

Any past experiences or rumors of forward thinking on behalf of insurance companies?

[sticker]

I have a very old and broad individual plan that I had in place before diagnosis. Little did I know at the time, buying that plan has been the best (luckiest) decision I've ever made.

Nowhere in the language of my dusty old policy did it exclude the pump, since it was issued long before pump technology but it was quite a challenge. Just like the pump, the CGMS has been the same struggle. They just didn't see the big-picture of the benefits for the pump and now the CGMS. I took the same tack with the CGMS as I did with the pump. I initially paid out-of-pocket and just kept after them until I got reimbursed. For the CGMS, I had to sue the company to get them cover the CGMS. They actually settled very quickly, as there was nothing in my policy that supported their denial. I have recently been paid for the Pathway upgrade from the 715 to the 722, as well as the starter kit. I just submitted a claim for the first sensor refill. MiniMed is working to directly bill my insurance, but for now, I have to pay for the order and submit my claim.

I don't believe the insured that is covered under an employee benefit plan has the same legal rights to sue for bad-faith as the holder of an individual plan. I believe there is a rule that protects the employer's insurance company that only allows the employee to sue in federal court and then only for actual damages. For that reason, I'm told that it's very difficult to find an attorney that is interested in taking the case since their pay-off isn't that great.

Getting the pump out-of-pocket was risky, as was getting the CGMS, before insurance approval, but for me, I was far more aggressive after having this stuff, than I would have been if I had waited. I would have been more likely to just blow it off had I never had this stuff.

Not that it does us any good, but we should all implore everyone we know, especially those without pre-existing conditions, to get their own high deductible, individual or family health insurance policy. I say high deductible, because in good times and bad, the premiums can be paid. Jobs can come and go, but an affordable high deductible health insurance plan can be owned for life, will allow the addition of newborns children without exception. As we know all too well, you can be healthy one day and diagnosed and un-insurable for life the next.