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State Law in Florida

Started Mar 13, 2010

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Medicaid Based Coverage in Florida

As of this last week we have been successful in obtaining coverage for a CGM (Dexcom) in Florida in a Medicaid Based HMO. The private provider was Healthease (Wellcare).A Clinical Guideline Policy now exists (HS-138).http://www.wellcare.com/WCAssets/corporate/assets/HS138_Continuous_Glucose_Monitoring.pdf See More

Mar 23, 2010

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"As of this last week we have been successful in obtaining coverage for a CGM (Dexcom) in Florida in a Medicaid Based HMO. The private provider was Healthease (Wellcare). A Clinical Guideline Policy now exists…"

Mar 23, 2010

thomas radcliffe posted a blog post

Medicaid Based Coverage in Florida

Mar 23, 2010

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thomas radcliffe posted a discussion

State Law in Florida

There should be no question!The 2009 Florida StatutesTitle XXXVIIINSURANCEChapter 627INSURANCE RATES AND CONTRACTS627.6408 Diabetes treatment services.--(1) A health insurance policy or group health insurance policy sold in this state must provide coverage for all medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patient's treating physician or a physician who specializes in the…See More

Mar 13, 2010

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thomas radcliffe posted a blog post

CGM Medicaid Florida

Hi,I am the Permanent Legal Guardian of a 9 year old type 1. She has had a prescription for a CGM for months now and her insurance, which is a Medicaid based HMO has denied coverage.We have been through a grievance, first level appeal, second level appeal, an administrative reconsideration of the second level appeal, and are now beginning the State Administrative Fair Hearing process before a hearing officer.And we are likely to lose. We have done all of the right things, given them all the…See More

Oct 17, 2009

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Profile Information

Which insurance company denied you?: Healthease

What kind of CGM do you have/want?: Minimed Real-Time or Guardian

How did you hear about the CGM Anti-Denial Petition?: web

Thomas radcliffe's Blog

Medicaid Based Coverage in Florida

As of this last week we have been successful in obtaining coverage for a CGM (Dexcom) in Florida in a Medicaid Based HMO. The private provider was Healthease (Wellcare).

A Clinical Guideline Policy now exists (HS-138).

http://www.wellcare.com/WCAssets/corporate/assets/HS138_Continuous_Glucose_Monitoring.pdf

Posted on March 23, 2010 at 2:51pm

CGM Medicaid Florida

Hi,

I am the Permanent Legal Guardian of a 9 year old type 1. She has had a prescription for a CGM for months now and her insurance, which is a Medicaid based HMO has denied coverage.

We have been through a grievance, first level appeal, second level appeal, an administrative reconsideration of the second level appeal, and are now beginning the State Administrative Fair Hearing process before a hearing officer.

And we are likely to lose. We have done all of the… Continue

Posted on October 17, 2009 at 9:00pm

Comment Wall (1 comment)

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