Are you, or is someone in your family, using a continuous glucose monitor (CGM)? Are you considering using a CGM? If so, you probably know that most health plans currently provide either limited or no coverage for these devices. In the coming months, JDRF will step up its efforts to expand health plan coverage for the CGM. You can join this campaign by responding to this short survey. The first step is to let the JDRF know your healthcare provider.
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• By joining this site you agree to the Terms/Conditions

• If you have any useful information that you would like to see on this site please contact Gina Capone

• If you have been covered, tell me what kind of plan you have through your insurance. For example is it Carefirst BC/BS of Maryland (PPO) or (HMO). What kind of individual plan you have makes a difference. Contact Gina

•Tell us what steps you took to gain coverage through your insurance plan, and post them in your STATE CATEGORY along with the insurance company that covered you.

Here is a nice list of tips to help families navigate the difficult and frustrating process and help increase the odds of success, are posted on the JDRF Artificial Pancreas Project website at www.jdrf.org/cgmcoverage.

Below are the tips!

1. Be prepared and persistent. Seeking case by case coverage is difficult; however insurance companies are granting case by case coverage to some individuals. Make sure to be prepared and to keep trying!
2. Get informed and get help. Read your insurance plan's guide or call your insurance company to learn the proper steps for seeking case by case coverage. Contact your continuous glucose monitor (CGM) manufacturer's customer service staff to see how they can help you.
3. Ask questions. Ask your insurance company if they have a prior authorization policy, an insurance policy that you must have approval before purchasing the device, and satisfy those requirements before asking for coverage. Also, find out what medical equipment suppliers your insurance plan works with and plan to buy your device through them.
4. Communicate the urgency for continuous glucose monitor (CGM) coverage. To better your chances of receiving a positive coverage decision, you must communicate urgency by highlighting health problems and the expenses of acute care.
    In particular, you will need to provide the following materials to your insurance company:
   - Letter of Medical Necessity from your doctor which highlights health problems and your need for continuous glucose monitor (CGM), which may include: 
   - Documented glycemic control problems (elevated HbA1c, frequents hypoglycemia, hypoglycemia unawareness, overnight hypoglycemia)
   - Hospitalizations for hypoglycemia or DKA
   - Emergency room visits
   - Glucagon administrations
   - Diabetes complications, whether early or advanced, such as kidney problems, nerve damage, loss of feeling in feet, and eye problems
   - Prescription for continuous glucose monitor (CGM) and sensors from your doctor 
   - Description of your current care plan (e.g. multiple daily injections or insulin pump, and frequency of self monitoring of blood glucose) and a record of adherence to your care plan from you physician 
   - Certification that your physician or other provider (e.g. Certified Diabetes Educator) will be supervising your care and maintaining your treatment plan with the addition of continuous glucose monitor (CGM)
5. File for case by case coverage. Send the materials to your insurance company.
6. Know your insurance company's appeals process. Since continuous glucose monitor (CGM) is not widely covered by insurers, it is likely that you will be initially denied coverage and you will need to appeal the decision.
7. Submit your appeal. Send the appeal to your insurance plan with the materials outlined above in Step 4 within the timeframe outlined by your insurer.
8. Appeal, appeal, and appeal. The more you appeal each denial, the more you are helping put pressure on insurance companies and make them aware of the demand for coverage of these devices. Don't give up!

Two JDRF-Funded Studies Show Regular CGM Use Increases Diabetes Control for All Age Groups and Enables Patients to Maintain Good Control Long Term
Studies Link Improvements in Diabetes Control to Frequency of Use and Demonstrate Continued Improvements 12 Months After Use, with "Remarkably Low" Occurence of Severe Hypoglycemia . Read More>>


JDRF Funded Clinical Trial Demonstrates Continuous Glucose Monitoring Improves Blood Sugar Control
Study Findings Presented at the European Association for the Study of Diabetes meeting and Reported in the New England Journal of Medicine Indicate CGM Can Help Type 1 Diabetes Patients Lower HbA1c Levels, Better Control Diabetes

Here is the link to the study:
CGM and Intensive Tx of DM1.pdf

DiabetesTalkfest.com launched the CGM Anti-Denial Campaign Petition on July 14, that will be sent to all major Health Insurance Providers. The goal is to get at least 2000 signatures by November 14, 2008—World Diabetes Day.

Current number of signatures as of 10/08/08: 2,324
Number left till goal: 0
Our goal has been reached!

I have created a forum for every state in the U.S. find your state category and please provide the following (you can use NEW YORK AS A GUIDE):

1. Identify the person(s) by State and Country who have the power to make it mandatory for insurance companies to cover CGMs.

2. Identify the lobbyists by State and Country who will go to bat for us to bring this forward.

3. Find a website link to the "law" that is currently in place regarding diabetes supplies coverage in your State or Country.

4. Find out by State and Country what has to be done in order to make this happen.

STEPS FOR OBTAINING CASE BY CASE COVERAGE FOR CONTINUOUS GLUCOSE MONITORS (CGMs)
Many health plans are waiting for the results of more studies like JDRF's clinical trial on continuous glucose sensors before making broad coverage decisions. However, in the meantime, some health plans are granting individual or case by case coverage. We encourage people who are using or plan to use continuous glucose monitor (CGM) technologies to apply for case by case coverage. Here are a few tips we have obtained from insurance experts that can increase your odds of success. More from the JDRF>>