CGMS and Insurance Companies

[Cyborg]

Has anyone been able to get their insurance company to cover a Continuous Glucose Monitoring System? Hoping to get info on United Healthcare and the details regarding coverage for the initial CGMS kit and the monthly supply of sensors.

[kgm0612]

Please let us know how you make out. I also have United Healthcare and from what I've been told, it's not covered. But you know how the customer reps are..........one tells you one thing and another tells you something else!

Karen

[JediSkipdogg]

I contacted Humana (my insurance) about this and they said at this time they are not covering CGMS since it saves no money since you still have to do numerous fingersticks to calibrate and before you make any adjustments.

[Cyborg]

I contacted Humana (my insurance) about this and they said at this time they are not covering CGMS since it saves no money since you still have to do numerous fingersticks to calibrate and before you make any adjustments.

To them, it all boils down to money... What a shame! If they thought it out, they would realize that they could be saving money in the long run by approving coverage for these devices and possibly preventing complications. I suppose it won't happen until the FDA approves them to replace fingersticks while "only" needing the fingersticks for calibration purposes.

I am going through with the process and will attempt to get reimbursed, so I will report the insurance nightmare I'm sure awaits me. I'm pretty convinced that I will lose the battle at this time, but it doesn't hurt to try.

[JediSkipdogg]

To them, it all boils down to money... What a shame! If they thought it out, they would realize that they could be saving money in the long run by approving coverage for these devices and possibly preventing complications. I suppose it won't happen until the FDA approves them to replace fingersticks while "only" needing the fingersticks for calibration purposes.

I am going through with the process and will attempt to get reimbursed, so I will report the insurance nightmare I'm sure awaits me. I'm pretty convinced that I will lose the battle at this time, but it doesn't hurt to try.

It does boil alot down to money. But when you think about how much us diabetics are costing insurance companies you see the problem. I used around $8000 in supplies a year, and my work only pays $7800 ($650 a month) a year for me. My brother pays $4200 ($350 a month) a year and he uses probably around $5000 a year in supplies/office visits.

While it may save money later on down the road if a complication happens, they are willing to take that chance since the majority of diabetics will be on Medicaid/Care before a major complication happens, therefore taking the burden off of their back.

The medical industry in the US is a totally messed up system and that is mainly caused by lack of control from the government. Massachusettes is the first state to pass MANDATORY (meaning you don't have it, you get fined) insurance for all, therefore hopefully lowering the premiums and costs for everyone. Hopefully it will work out in MA and the system will be applied in other states and maybe even nationwide, which would be the best system.

[spike]

I contacted Humana (my insurance) about this and they said at this time they are not covering CGMS since it saves no money since you still have to do numerous fingersticks to calibrate and before you make any adjustments.

That's why I'm looking forward to the navigator. You will be able to change your therapy based on the readings, without having to double check with a handheld meter. shame on MM! :)

[camjen1]

The info packet I got regarding the Guardian said it is patient pay only at this time. Let me also add that anyone who is considering the Guardian but found out they are not available in your area might want to call Minimed and find out FOR SURE. I say this because I got a packet saying they were available in my area but yet my area is no where near the cities they selected to disburse in.

[JediSkipdogg]

That's why I'm looking forward to the navigator. You will be able to change your therapy based on the readings, without having to double check with a handheld meter. shame on MM! :)

Hopefully it will be approved that way. Heck, the CGMS was marketed by Minimed's trainers as not needing anymore fingersticks but 2 a day to calibrate, and it was the FDA that manditated they add on thier information that it's not a replacement and that before any corrections (insulin or food) are given a fingerstick should be done. So hopefully the Navigator will get approved without that little notation which is what turns insurance companies away from it.

[spike]

Hopefully it will be approved that way. Heck, the CGMS was marketed by Minimed's trainers as not needing anymore fingersticks but 2 a day to calibrate, and it was the FDA that manditated they add on thier information that it's not a replacement and that before any corrections (insulin or food) are given a fingerstick should be done. So hopefully the Navigator will get approved without that little notation which is what turns insurance companies away from it.

Yup! I'm hoping the same thing! I know that things can change from promises made now by Abbott, to reality when it hits the market. My fingers are firmly crossed. :)

[Cyborg]

Has anyone, anywhere had luck with any insurance company paying for a CGMS?