Giving up hope...

Dewey · #1 (**permalink**) 04-29-2007, 01:05 AM

about insurance covering the CGMS....

I know this is so petty, but have been a bit frustrated by this lately. See, the thing is, I've known since February that I wanted the Guardian CGMS unit. I got in touch with MM & my endo & did all the things needed (some took a little longer than expected, but that's ok), but as usual, insurance seems to want to be a PITA. I faxed my paperwork to them twice (first time, I forgot the policy #s on there.....but, the irony was they sent the paperwork back to me after I faxed it a second time with the numbers on it, saying they didn't know who I was). The biggest irony is, they claimed they (in their words) "don't know this patient," yet they cover every bloody doctor appt. I go to! HELLO!

I sent the paperwork via snail mail Certified! I figure one way or another, they're going to receive it. I've been trying to be patient, but by gosh, I don't think it should take 3 to 4 months to get something that could aid immensely with control. After ALL the legwork & stuff I've been through to try & get it, they ought to darn well cover it. If they don't, Look out (lol) - the wrath of Dew shall fall upon them & I'll go after them full force!

camjen1 · #2 (**permalink**) 04-29-2007, 08:03 AM

Dewey I'm going through my own hurtles just to upgrade to the 722 without CGMS. Real pain in the butt if you ask me. I never had this much trouble when first getting the pump. Just when I thought I was done submitting everything BAM I get a letter in the mail from my insurance stating I needed to submit months of blood sugar numbers. WTH!!! They couldn't tell me this a month ago or better yet they couldn't call me to tell me that? No instead lets send her a letter so that it takes even longer.

Sorry Dewey but hopefully your insurance company will come around more quickly once they know the wrath of Dewey will be upon them.

kgm0612 · #3 (**permalink**) 05-01-2007, 07:43 AM

Hang in there Dewey. I know you're frustrated but hopefully things will work out for you.

United Healthcare flat out said "NO.....not covered". I even went and met in person with a United rep at their office here in RI to straighten out the claims that they haven't paid for test strips & pump supplies, and even asked the rep to look into the matter of the CGMS for me. NO LUCK! My endo tells me to be "patient".........he is confident by year end they will start paying.

Karen

jenet · #4 (**permalink**) 05-01-2007, 08:09 AM

Well, darn! I am still keeping my fingers crossed for you that it's just the usual tangle of paperwork. I'm looking forward to your comments on how to get the most out of the CGMS.

Good luck!
j

Dewey · #5 (**permalink**) 05-01-2007, 11:05 AM

Thank you all. Jenet, I look forward to being able to share experiences with the cgms.

I have some more news....

Went to my Endo yesterday for a regular 3 month checkup. He was pleased with my levels, as I haven't been experiencing as many lows.

I also realized (on my own....) what was going on with the highs. It used to be that the week before menstrual cycles, I'd run low more often....well, good ole' hormones, etc., have now caused a 180 degree turn, and I now seem to experience highs the week before. Uggg, lol.

Anyway, based on some of the things I'd read on the forums (with regard to pharmacists & other doctors saying people test too much), I explained what some of the pharmacists & other docs were saying & asked for my endo's take. All I can say is, "Good answers, & good man."

His response was that those people (pharmacists & even other docs/endos) simply do Not understand the dynamics of Diabetes. They do not get that constant testing will promote long term health & provide a better view of what's going on (& how to correct anything that comes up or goes down) along the way.

Needless to say, I was very pleased with his answer & commentary.

We also discussed what was going on with the insurance coverage on the CGMS, and he said not to lose hope. I told him I was up for the fight, one way or another. He also asked if they didn't cover it, would I still be interested or able to get it? I told him I'd do whatever I could. Both he & I feel it would be a very important & beneficial tool in catching BGs before they get out of hand, one way or the other. Likewise, it will aid in knowing when changes are coming on (i.e. pre-menstrual).

Overall, it was a good visit. I do have a question though....should I call MM and ask about whether they offer a payment plan (in the event insurance won't cover)? I'd like to go ahead & get the CGMS one way or the other, but would rather make payments if possible (don't think we could swing the full payment at the moment).

Tish · #6 (**permalink**) 05-01-2007, 11:24 AM

Hi Dewey

Sorry to hear your insurance co. is giving you such a hard time over this. I was interested in these as well but my endo said not to even try since he is familiar with my insurance co. He said to wait a good while and then we'll try. They won't cover an upgrade to my pump either. I spent nearly a year fighting them because they stopped paying for my a1c's at my appointments. (And the manager of our account is a Type 2). When I finally threatened to stop having them done they changed their tune. But they still won't cover a glucagon kit. I have to pay for that one myself.

I think calling Minimed and seeing if they can help you out while you try and get the insurance co. to stop trying to breathe with thier heads stuck up you know where is at least worth a try.

Good luck.

Dewey · #7 (**permalink**) 05-01-2007, 11:39 AM

Quote:

Originally Posted by Tish

Hi Dewey

Sorry to hear your insurance co. is giving you such a hard time over this. I was interested in these as well but my endo said not to even try since he is familiar with my insurance co. He said to wait a good while and then we'll try. They won't cover an upgrade to my pump either. I spent nearly a year fighting them because they stopped paying for my a1c's at my appointments. (And the manager of our account is a Type 2). When I finally threatened to stop having them done they changed their tune. But they still won't cover a glucagon kit. I have to pay for that one myself.

I think calling Minimed and seeing if they can help you out while you try and get the insurance co. to stop trying to breathe with thier heads stuck up you know where is at least worth a try.

Good luck.

Hi Tish, and thanks so much. Sorry to hear you've had to fight so much with your insurance. I've noticed that over the last few years, things have become more difficult to get coverage for than ever. That, in & of itself, is frustrating for all of us.

I called MiniMed and they said the only way they offer payment plans is when a user is doing a pump purchase in conjunction with the CGMS system. They do not offer it for the standalone, unfortunately. That said, she did make some comments regarding insurance billing codes & that was where the biggest issues lie. Insurance has asked my doctor for the proper billing codes and because the CGMS system is so new, some do not know the appropriate codes (if any) to use. That said, there's a thread here that links to another site where codes are provided. I think I'll get them & fax them to my endo. Perhaps that may help.

If all else fails, I can ask hubby if we'd be able to save up for the full payment & worry about reimbursement later.

Thanks again.

Tish · #8 (**permalink**) 05-01-2007, 12:10 PM

Ah yes - the infamous "billing codes". That's what caused the issue over the a1c testing. That's what my endo said about my wanting to use these as well. He said it was all too new and it would take some time before everything caught up.

Bummer about Minimed not having a payment program available. I really thought they might.

Insurance companies and air port security - always a fun time with those.

I like your determination though. One way or the other.