Insurance and CGM

[melissata]

I thought that at least a few people were getting insurance to pay for CGM's by now. Is that true or is everyone just appealing right now? My friend's son just started having seizures due to lows and she wants to get him one. His blood sugar was not that low, only 60 and he had a full blown seizure the other day. I think that this would be as good a case as any, but she was told by someone else that no one is getting them paid for by insurance yet. Any advice would be helpful, thanks.

[JediSkipdogg]

Quite a few are getting them paid by insurance. Now, my insurance won't pay for the reciever/transmitter but they will pay for the sensors. So I've been appealing the initial start up kit for about 2 months now just waiting to hear back from the review board after I sent them a 20 page document.

Some insurances are finally starting to cover without any appeal required since either they have enough subjects using them or they have a medical advisory board that sees the justification for one.

So some insurances will cover them without appeals, some with appeals, and some never. And it's really hard to say which companies and heck, every state's version of the same company is like a new company.

[xMenace]

Any chance I could get a copy of your document?

[ctskierguy]

Any chance I could get a copy of your document?

Could I also?

I have just been denied by BCBS of Texas. So if anyone has any info on getting them to approve it, please let me know.

I'm paying out of pocket for the whole thing right now. I'd rather not, but I feel that it's something that I really need regardless of the cost.

Mike

[JediSkipdogg]

Any chance I could get a copy of your document?

Sure, PM me your email, but I'll start off by saying that it's really about 10 documents found on other websites combined into one. I figured if I'm going to send a letter why not send everything I can find at once.

[Funnygrl]

I got coverage. They did a curtosey pre-authorization for me. I had to send in a letter of medical necessity, a month of blood sugar logs, and documentatin of my ER visits for lows.

[iDream]

My parents insurance completely covers the pump and gcm.

[jeggeman31]

My insurance covered it with only a letter from my Dr. I would tell your friend to contact the company she wants the CGMS from and let them do the leg work with the insurance company. I did nothing but ask for CGMS. My Dr office and Minmed did the rest.

[palefacegirl03]

Could I also?

I have just been denied by BCBS of Texas. So if anyone has any info on getting them to approve it, please let me know.

I'm paying out of pocket for the whole thing right now. I'd rather not, but I feel that it's something that I really need regardless of the cost.

Mike




Mike ,

I was just told yesterday by my pump trainer that BCBS of Texas is now covering the CGMS, hopefully you can get coverage now.

I live in Texas, but my BCBS in Anthem out of Va, so they aren't covering yet.

[ctskierguy]

Mike ,

I was just told yesterday by my pump trainer that BCBS of Texas is now covering the CGMS, hopefully you can get coverage now.

I live in Texas, but my BCBS in Anthem out of Va, so they aren't covering yet.

If that's trur then I'm one happy camper!

I've got to call Medtronic in the morning and see what they've found out.

Thank you very much for the good news!

Mike

[kidvid]

A Dexcom rep just told me that United Health Care was the only company he knew of that always paid for CGM. I'm in the process of getting mine. But the rep is a real schmoozer. Dexcom files the claim for you, but you have to pay up front. They will split the cost of the initial purchase into three payments in order to mitigate the impact, and delay the need to pay until the insurance company comes thru.

Joe

[ctskierguy]

I just got off of the phone with BCBS of Texas. And the nce woman at the other end could not verify that BCBS of Texas had changed anything as far as covering CGMS. :confused:
So if anyone knows anything, or anyone at BCBS of Texas who can get me some concrete answers please let me know.
Thanks to everyone,

Mike

[palefacegirl03]

I just got off of the phone with BCBS of Texas. And the nce woman at the other end could not verify that BCBS of Texas had changed anything as far as covering CGMS. :confused:
So if anyone knows anything, or anyone at BCBS of Texas who can get me some concrete answers please let me know.
Thanks to everyone,

Mike


You might want to speak with someone at Minimed and see if they know what is going on. It was my Minimed trainer that told me BCBS of Texas was covering CGMS now, so that is all I know about it. good luck

[jeggeman31]

I just got my EBO from United Heath. MM billed my insurance $999.00 and UHC claims their network discount is $1,000 so thus per UHC MM is giving me the stuff for free. Now I am sure MM will resubmit the bill, but I thought it to be funny as UHC thanked me for using a network provider.

[Keezheekoni]

Jim, what billing code did they use to bill the CGM under? I have UHC and would like to find out what the customer service people say about it with my plan. The last time I called there weren't any codes for her to look it up with, and so she just told me what my actual certificate of coverage says, word for word, about diabetes supplies.

[jeggeman31]

Jim, what billing code did they use to bill the CGM under?

I just looked and I don't see it listed anyplace.

[dgrilli]

A Dexcom rep just told me that United Health Care was the only company he knew of that always paid for CGM. I'm in the process of getting mine. But the rep is a real schmoozer. Dexcom files the claim for you, but you have to pay up front. They will split the cost of the initial purchase into three payments in order to mitigate the impact, and delay the need to pay until the insurance company comes thru.

Joe

I'm also going with the Dexcom Joel, but my reps are kinda taking their time sounds like they getting it done though. I have UHC also.

Why did you choose Dexcom? Sounds like if I go with MedTronics the process would be speeded up.

[lpowell]

I am also in the process of appeal with Anthem of Va. But just found out last week my company is swicthing to Southern Health. I have never heard of this company and was wondering if they would approve a CGM pump? Anybody have Southern Health?