Continous blood glucose monitoring

sharishine · #1 (**permalink**) 05-04-2007, 04:05 PM

Has anyone obtained the new continuous blood glucose monitoring system from minimed? My father who is a Type I (as am I), has purchased it. Unfortunately, the insurance company will not reimburse him for it because it is still "so new". I'm just wondering if anyone else has purchased one of these and if so, what experiences have you had with insurance companies?

Thanks!

Jackets · #2 (**permalink**) 05-04-2007, 11:30 PM

The Guardian® REAL-Time Continuous Glucose Monitoring System

This is the first I've heard of it. Very interesting.

catgalla · #3 (**permalink**) 05-05-2007, 01:11 AM

I'm dying to get that monitoring system for myself. My diabetes nurse educator informed me the other day that insurance should be covering that really soon. I think it's a wonderful idea.

rocky · #4 (**permalink**) 05-05-2007, 02:35 AM

I am getting one with my pump within the next few weeks. I believe my company covers the same for it as they do the pump. I'll let you know more once I actually get it. I am definitely excited about it, to know what my BG is at all times of the day.

sharishine · #5 (**permalink**) 05-05-2007, 05:26 AM

I will be surprised if they cver it the same way they do your pump. My insurance company, and my fathers, both cover our pump and supplies, but WILL NOT cover this new insulin pump - and supplies (which is where it gets expensive). Please keep me updated on what your ins company decides. Thanks!!

cat_collector · #6 (**permalink**) 05-05-2007, 08:20 PM

Hi , Im waiting to hear if my ins is going to cover this , when I called them they said they would cover it so my endo is sending in the order well see what happens .

Tracy

atlfokus · #7 (**permalink**) 05-05-2007, 10:08 PM

I'm working on getting this in a month or so...

I have to wait for my warranty to expire on the one I have currently, then I have to get approved I guess.

I dont think my insurance is going to cover it at first, but I was told as time goes on and it gets more popular, they most likely will. But for now, it going to be like $350/month for supplies.

I've talked to a few people who claim its just amazing, and a friend of mine got to test it for three days and she agreed 100%... I can't wait.

..pCe..

Keezheekoni · #8 (**permalink**) 05-06-2007, 12:51 AM

Insurance companies who cover a pump will cover this one, just without the CGMS. It's just their regular pump with the added ability to work with their CGMS...

I hear that most insurance companies will begin covering the CGMS part of it sometime next year, however knowing insurance companies like I do, most will probably deny coverage until you appeal their decision a few times.

There are a few people on the board here who have gotten their insurer's to cover it. Hopefully they'll post soon.

It Ain't Over · #9 (**permalink**) 05-09-2007, 10:08 AM

Had a discussion with the Mini Med CDE last night. She said the problem is there still is no HCFA # for the Minilink, and none for the CGMS.
Without that the insurers refuse to recognize this as a medical device. So it takes additional effort to get them to accept the rx your doctor sends in. Said those with success have gone up beyond the first and sometimes beyond the second levels of no sayers to get approval. Takes both yours and your MD's effort to get it done.

orsaugen · #10 (**permalink**) 05-09-2007, 10:22 AM

DexCom reports that Medicare/Medicaid is favorably disposed towards approving coverage for its CGMS. There was a public meeting on May 1 (no reports out yet) and the excpectations are that at least the DexCom device will receive a HCPCS code by January 1, 2008, when Medicare and Medigap will cover the devices and, we hope, the consumables.

Harold · #11 (**permalink**) 05-09-2007, 12:03 PM

Moved thread to Monitoring.

How much does it costs without insurance? As a type2 not on insulin it may not be necessary to wear it everyday, say 3 days a week. Getting a real picture of what's happening over the course of the day will show up problem areas not seen with finger sticks. Know I have them comparing A1c with monitor averages shows I am missing something.

sharishine · #12 (**permalink**) 05-09-2007, 04:49 PM

It Ain't Over: What exactly is the HFCA# and the CGMS?

The insurance companies will pay for the actual pump, because its just a pump. Its the sensors that they will not cover yet.

spirosway · #13 (**permalink**) 05-10-2007, 06:33 AM

In others countries your insurance pays for continus glycose monitor?In Greece all these stuff are very very expencive!!!you need 1000E or 1300$ for monitor and other stuff 1000$ every month!!!its crazy!!!

bizonia · #14 (**permalink**) 05-11-2007, 02:19 AM

I am on this system(PRT by Minimed) for already 2 months ,but I am disappointed with it.I don't know when to trust it and when not.Some days its reading(BG)are correct,some are not.Sorry if it sounds not so nice,but I am sure they will approve it, so there is a hope! I really do not mean to be critical at all , I just share my experience with you.

rmccully2000 · #15 (**permalink**) 05-11-2007, 09:08 AM

These are billing codes the insurance companies use.

It is NOT true that insurance companies won't cover CGM until the CMS creates specific codes for it!!! Don't buy it if your insurance company or an endo or CDE gives you this line. It is misinformation.

We obtained insurance coverage of Dexcom on the first try using miscellaneous durable medical equipment code. MM and Dexcom reimbursement specialist have these codes if you need them.

We now pay 10% for all CGM supplies (about $17.50 per month) since we also won in-network approval recently.

Best of luck!
Becky,
Mom to Mason, 7 Dexcom

Quote:

Originally Posted by sharishine

It Ain't Over: What exactly is the HFCA# and the CGMS?

The insurance companies will pay for the actual pump, because its just a pump. Its the sensors that they will not cover yet.