Appealing the cgms - Page 4

NoelD · #46 (**permalink**) 06-07-2007, 12:14 PM

Quote:

Originally Posted by BlueSky

But then you started the pump back in the bad old NPH days. Have you tried Lantus oir Levimer. My HBA1c was also 8+% when I was on NPH. Some dietary changes and switching to Lantus brought it down below 6.5%. A pump wasn't neccessary. They don't call Lantus the "poos man's pump" for nothing.

I was on Lantus and Apidra and switched to the pump with apidra.

Dewey · #47 (**permalink**) 06-07-2007, 12:44 PM

Quote:

Originally Posted by BlueSky

But then you started the pump back in the bad old NPH days. Have you tried Lantus oir Levimer. My HBA1c was also 8+% when I was on NPH. Some dietary changes and switching to Lantus brought it down below 6.5%. A pump wasn't neccessary. They don't call Lantus the "poor man's pump" for nothing.

Ummm, no. I was on Ultralente, Not NPH. While I had used NPH in the past, I was not on it the entire time prior to pump therapy. I had been using Ultralente for quite some time prior to pump therapy, and still was unable to achieve satisfactory A1Cs. Ultralente basically had the same attributes of Lantus or Levemir, in that it was a steady basal insulin.

Personally, I have absolutely No interest in trying Levemir or Lantus, or going back to MDIs. I've heard that Lantus can pool under the skin (which can cause absorption issues or cause a lack of proper absorption), and I'm not a big fan of putting yet more types of insulin into my body that contain that "wonderful" m-cresol (preservative). I have no qualms in taking shots or even doing the "untethered" regimen if & when needed (provided I can use Ultralente, not other types of long-acting), but since I've been doing quite well on the pump & have been able to achieve excellent A1Cs, why ruin a good thing!?

We need to realize that not everyone can be controlled via shots & shots alone. I'm just one of many who are "living proof" of that.

Tony, sorry if I distracted from your thread in any way, and I sure hope you get the coverage needed for your CGMS. Please continue to keep us posted on your progress regarding the MM CGMS. Your fight may help others who have problems getting theirs covered.

cat_collector · #48 (**permalink**) 06-16-2007, 01:00 PM

I have been working with my ins company since late April just trying to get a yes or no . Finally this week I got a supervisor that was a bit ticked that have been not geting back to me and dragging this out . I should have my answer Mon or Tue and I feel confident that they will cover it . It old her i was ready to just give up and she told me to NOT do that so if it is NO i will appeal it .

I have not been able to find a price on these can anyone give me an idea ?

Tracy

JediSkipdogg · #49 (**permalink**) 06-16-2007, 01:46 PM

Quote:

Originally Posted by cat_collector

I have been working with my ins company since late April just trying to get a yes or no . Finally this week I got a supervisor that was a bit ticked that have been not geting back to me and dragging this out . I should have my answer Mon or Tue and I feel confident that they will cover it . It old her i was ready to just give up and she told me to NOT do that so if it is NO i will appeal it .

I have not been able to find a price on these can anyone give me an idea ?

Tracy

The MM system is roughly $1400. The Dexcom is $800. The new Dexcom Seven (not available for purchase as it was just FDA approved a few weeks ago is $1300. The sensors are $35 for days wear foir both the MM and the original Dexcom and $60 for the Dexcom Seven.

Now, some may say those prices are different, however, those are the prices insurance companies MUST go by.

cat_collector · #50 (**permalink**) 06-23-2007, 05:57 PM

My CGMS was aprroved ! it only took since April but Im glad they finally got with it . I got a call from minimed and my Nurse case worker at my Ins co. They called my mail order Pharmacy to see if they would process it so I would have no co pay . Now I just wait bcs the sensors are on back order .If any one really wants this they should push there ins company sometimes it just takes persistance to get things done .

Tracy

kgm0612 · #51 (**permalink**) 06-25-2007, 06:35 AM

Congratulations Tracy.........I hope the sensors aren't on backorder too long!

I have an endo appointment today after work and I'm going to talk to him regarding the CGMS. I'm also curious to hear from him if there's any "new & improved" items expected out on the market in the near future.

Karen

kgm0612 · #52 (**permalink**) 06-26-2007, 06:13 AM

I saw the endo yesterday. He's going to write a letter of necessity for the CGMS but already warned me that United Healthcare has been denying them. I'm going to put in a call to United today and want to speak to an information specialist, not just a rep. My endo wants the name & address of the person he should address the letter to.

A1c was 6.8, down from 7.1 three months ago. My blood sugars throughout the day are pretty good.........it's a roller coaster ride after dinner though. I hate this disease!

Karen

nab486 · #53 (**permalink**) 07-03-2007, 07:25 AM

I have a question.... everytime I call BCBS they tell me Minimed has to call them... then I call Minimed and they say they can't call the insurance company .... am I not talking to the right people??? How do I get this ball rolling? I have already purchased the CGMS but would love to get the sensors covered.

Worldcrzr · #54 (**permalink**) 08-14-2007, 12:30 PM

By Googling California laws for diabetics, I found this link. It lists most of the states and their laws concerning diabetes supplies. Maybe it will help someone.

Diabetes: State mandates for insurance coverage

SPowell42 · #55 (**permalink**) 09-20-2007, 10:48 PM

My insurance company has the same verbage. It has nothing to do with the old Guarding. The insurance companies are trying to argue that if you use a CGMS for 3 days, twice a year, you can learn enough trend info to maintain your diabetes without having CGMS continuously.

Just another way they are trying to weasel out of this.

Scott

Quote:

Originally Posted by JediSkipdogg

Tony, it sounds to me like they may have no idea what you are fully talking about. What it seems like they think is you are using the old Guardian at a doctor's office. Therefore they are looking at the cost of that. And in those terms, that cost is ALOT greater. It's like $250 for a 3 day wear. So instead of $5200 a year, they are thinking $30,000. Just a thought that maybe you could use if you decide to appeal again. Explain that it is a device that is home use and does not require expensive doctor visits anymore than you have now.

dgrilli · #56 (**permalink**) 09-25-2007, 02:48 PM

Anyone have any information for the State of Pennsylvania and I have United Health Care.

Does Pennsylvania have similar laws?

RobiJo · #57 (**permalink**) 09-25-2007, 03:35 PM

How/Where can I find this information for my state? (Michigan)

Tony · #58 (**permalink**) 09-25-2007, 03:37 PM

Quote:

Originally Posted by RobiJo

How/Where can I find this information for my state? (Michigan)

Here is the link for Michigan,
http://www.legislature.mi.gov/docume...00-PA-0424.pdf

Funnygrl · #59 (**permalink**) 09-25-2007, 04:13 PM

Quote:

Originally Posted by JediSkipdogg

Total price based on today's values for a CGMS is $225,917 ($4518.34 per year). The average price for an ER visit was $202 in 2002 (I couldn't find today values but I searched briefly) and for an ER admit was $8,049.

I have no idea what that ER visit included for $202 but I went to the ER for a hypo and my insurance paid $9000.

dgrilli · #60 (**permalink**) 09-26-2007, 04:52 PM

Quote:

Originally Posted by Tony

Here is the link for Michigan,
http://www.legislature.mi.gov/docume...00-PA-0424.pdf

What about Pa? Tony