Independence BC PA

[Stacey]

I'm currently fighting the insurance company for coverage of my Dex.

I just got off the phone with the investigation specialist handling my case at BC.

He gave me some amazing news...IBC is in the process of rewriting their policy on CGM coverage as I type this post. From what I was told CGM will need to be precertified by a physician and there will be certain criteria that must be met but coverage is COMING and soon.

:)

[Gina Capone]

Stacey,

I hope it works out for you, unfortunately I have heard that before. They always say they are changing their policy bla bla bla but, you still get denied. Its BS.

I will keep my fingers crossed.

[Laurie]

Hmmm....there's a gal in PA that won coverage with a lawsuit again BCBS PA (I don't know if that's the same as yours) and part of the settlement terms were that the policy would be changed. They are though dragging their feet....

BCBSTX pulled the "we are reviewing" line on me and later the representative told me she had lied. I sent that to the Attorney General with my complaint.

I hope yours changes!!!

[Stacey]

Thanks for your replys...I'm definitely praying that what the specialist told me on the phone is the truth although I'm not giving up my fight.

Honestly, I'm wondering if or how much the study and press release from JDRF this week has affected how the insurance company can/will deal with CGM.

[Darryl]

Independence Blue Cross released their updated CGMS policy 5.00.24e this week.
CGM's are now covered for Type 1 diabetics meeting 5 criteria

See my post here:
http://forums.childrenwithdiabetes.com/showthread.php?t=25224

The complete policy may be viewed on the IBC website
http://www.ibx.com/providers/policies_guidelines_pubs/medical_polic...

Click "accept and go to medical policies online"
Select "Commerical" policies
Enter "CGMS" in the search window
Click on policy 5.00.24e

I want to point out that this new policy includes in its references the JDRF article published last month in the New England Journal of Medicine.

[AbbyDabbyDoo]

That is encouraging news!
Good luck!!!

[Darryl]

IBC has begun paying for our Guardian sensors at 70% of cost (our cost now is around $10/sensor vs. $35 before insurance), and they also paid 70% of the cost of a new transmitter (ours was 18 months old and dying). So, the coverage is "real" and we are very happy.

[Leslie]

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