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All Blog Posts (22)

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




Added by thomas radcliffe on March 23, 2010 at 2:51pm — 2 Comments

Security of medical records

Health insurance and medical travel insurance, along with surgery or angioplasty results may be entered into a data base for medical personnel access. It seems as though this would benefit the patient as far as appropriate continuous medical… Continue

Added by lee w on January 24, 2010 at 8:30pm — 2 Comments

treatment with coverage

Insurance coverage is important for young families. Whether there is some sort of HSA or even Short Term Health coverage, young parents need the assurance that they can take their kid to the doctor.

I wonder if there has been research to determine of parents are less likely to… Continue

Added by Cindy Fallsen on December 9, 2009 at 2:44pm — 3 Comments

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

Added by thomas radcliffe on October 17, 2009 at 9:00pm — 2 Comments

Recently got HealthNet to reverse their denials and cover Dexcom CGM for our six year old son

We just recently got our son's (Calvin) CGM covered by HealthNet. He has been on the Dexcom for about a year and a half, it was costing us $250 per month for the supplies and we paid for the original device out of pocket as well because we wanted him on the CGM when he started kindergarten last year. Through much effort appealing denials we finally prevailed. Both his Pediatrician and his Pediatric Endocrinologist were very helpful and instrumental in getting HealthNet to overturn their denials… Continue

Added by Ron Anderson on September 22, 2009 at 11:04am — 3 Comments

Tricare Prime denied CGM because child under 7...

Hello everyone,



A bit of background: My daughter, Abby was diagnosed at 16 months in August of 06. She started on the Minimed insulin pump, March of 07 and the corresponding cgm June of 07. Tricare Prime (North Region) covered both cgm and insulin pump 100%. Recently (4 months ago) our cgm transmitter died a natural death (we have been using it 23 months, 24/7) and we submitted an insurance claim for a replacement. Surprise, surprise they are now denying us coverage. We are now in… Continue

Added by Kelly Houck on August 11, 2009 at 7:21am — No Comments

TRICARE and Navigator sensors

TRICARE considers CGM to be nice but not needed. Therefore, TRICARE will only approve three months worth of Navigator sensors at a time. Then, one must fight for additional coverage all over again.

Added by Marion J. Edge on May 21, 2009 at 8:00pm — 1 Comment

ANTHEM BCBS WI

ANTHEM BCBS OF WI DENIED MY CLAIM, STATUNG IT WAS BECAUSE i DIDN'T HAVE 2 INSTANCES OF BG BELOW 50 IN A 30 DAY PERIOD

Added by RON BARD on December 17, 2008 at 5:12pm — 1 Comment

Please email me about CGMS denials

Hello to all--



I am currently thinking seriously about a lawsuit (class action) on behalf of all persons with diabetes who need a CGMS and are being denied by their insurance company. However, I need your name and dates and insurance company names. If you have been denied, please email me at cjensen780@msn.com and tell me your story. I want to know what other insurance companies (besides mine) are denying this. We need to all band together and make them take us… Continue

Added by Christie Jensen on November 23, 2008 at 11:55pm — 6 Comments

My Type 1 Diabetes needs help!!!

HI,
I was wondering if anyone also had the pump with type 1 diabetes?
And is taking Humalog with the machine?
My AC1 test is about 8.3 I try to test as many times a day but my fingers cant take it anymore after 10 years!
Does anyone know if they have the option to take a Diabetec pill instead of the machine? I hate the pump!

Added by Michelle2008 on November 5, 2008 at 1:03am — 2 Comments

CGMS Saved the Day (again)

I've been paying out-of-pocket for my Minimed CGMS since March (still appealing insurance, and will have to start over because my work is changing insurance companies - UGH!!!). It's saved my ass more times that I can count.



Yesterday was another perfect example of why these things should be covered by insurance:



Sitting on my bed feeling a little hungry, but otherwise perfectly fine. I hear the melodic BEEP, BEEp, Beep, beep that indicates I'm going low. The CGMS tells me… Continue

Added by Shannon on October 30, 2008 at 1:45pm — 3 Comments

CBGM Denial

Thanks to Dr. Keith Osborne of Cigna health care, I was denied a monitor in June of 2008. On October 9, 2008 my blood sugar dropped to 25 while driving home from work. My car went off a cliff 200 feet into the Columbia River. These people need to wake up now. I am on my last life as I have used the rest of them up fighting this disease for the last 40 years.



Mr Garwood,



After a complete review of this request and available information Dr Keith Osborne provided the… Continue

Added by Steve on October 12, 2008 at 8:11pm — 4 Comments

Keep your fingers crossed!

Recently, I got a call from Medtronic Minimed directly to say they were going to be handling my CGM Appeals.



(GINA NOTE: I was denied 3 times and on the third denial I was also laid off from my job so I couldn't pursue further.



I went onto my husbands plan right after I got laid off. The next day I called up my CDE to tell her my insurance would be changing and that it was still the same…
Continue

Added by Gina Capone on October 11, 2008 at 7:46am — 1 Comment

A call from Medtronic Minimed

Yesterday, I was at work doing my daily duties and at about 2pm my cell phone rang.

Me: A little reluctant to answer because it looks like a spam caller I do anyway..Hello?

Caller: Ms. Capone

Me: Yes, that is me.

Caller: This is "M" from Minimed calling in regards to your appeal for a Continuous Glucose Monitor.

Me: A little…

Continue

Added by Gina Capone on October 8, 2008 at 12:30am — 3 Comments

won my appeal for Dexcom CGM

My Dexcom CGM was denied by BC/BS of California this past March. I appealed and it was denied again. I appealed a second time and an independent review was initiated. Three physicians ultimately looked at my claim and medical records. Two of them voted for overturning the the insurance company's denial of the claim, the other voted against me. In any case, I just won the appeal and my CGM is now covered. I have had Type 1 for 8 years and wear an insulin pump.

Added by Eva Clarke on October 5, 2008 at 10:39pm — 4 Comments

Ha, Ha, Ha Very Funny Aetna

The approval letter from Aetna arrived, then the cgms box from minimed arrived, and then the EOB arrived that rejected the claim. I guess the joke is on me!!! They had to make me jump through one more hoop to get coverage. It is such a scam. Anyway, I called and they resubmitted with the approval code that the rep found in my file. I guess this is how we keep people employed, insurance costs high and the economy going!?!?!?!?

Added by Jane on September 26, 2008 at 9:37pm — 1 Comment

Aetna letter arrived today...

They reversed their decision. They said "The submitted material is sufficient to document repetitive hypoglycemia even with multiple glucose checks on a daily basis. Coverage is allowed."

YEAH!!! :-) I am one happy mommy!!!!

Added by Jane on September 2, 2008 at 5:51pm — 1 Comment

Called Aetna Today

The person that answered the phone said there was a note in the system that said an appeal decision letter was mailed at 12:15 pm today. She could not tell me what it said.

Added by Jane on August 29, 2008 at 4:54pm — No Comments

Decision Date Approaching

Aetna said they will make a decision by August 30. That falls on a Saturday. I am going to call on Friday, hopefully they will have posted a decision on their system. I am crossing my fingers.
Jane

Added by Jane on August 28, 2008 at 1:14pm — 1 Comment

I'm still working on it........

Today I talk to Medicare about claims that Dexcom sent them... This what I understood what Medicare said... If Dexcom called Medicare and get somethings work out... Medicare would process the calims... So I called and email Dexcom to ask them to call Medicare.....

Added by Shawna Rene Staats, on August 25, 2008 at 12:02pm — No Comments

Members

Blog Posts

Medicaid Based Coverage in Florida

Posted by thomas radcliffe on March 23, 2010 at 2:51pm — 2 Comments

Security of medical records

Posted by lee w on January 24, 2010 at 8:30pm — 2 Comments

treatment with coverage

Posted by Cindy Fallsen on December 9, 2009 at 2:44pm — 3 Comments

CGM Medicaid Florida

Posted by thomas radcliffe on October 17, 2009 at 9:00pm — 2 Comments

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